Provider Demographics
NPI:1508949827
Name:ALEXANDER, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 TANGER BLVD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-4401
Mailing Address - Country:US
Mailing Address - Phone:812-523-3700
Mailing Address - Fax:812-524-2946
Practice Address - Street 1:357 TANGER BLVD
Practice Address - Street 2:SUITE 201B
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-4401
Practice Address - Country:US
Practice Address - Phone:812-523-3700
Practice Address - Fax:812-524-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050375A208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00695875OtherRAILROAD MEDICARE
IN000000202918OtherANTHEM
INP00695875OtherRAILROAD MEDICARE
IN230020AMedicare ID - Type Unspecified