Provider Demographics
NPI:1669437273
Name:ANDERSON, JOHN S (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:STE 402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:1914 SOUTHSIDE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1930
Practice Address - Country:US
Practice Address - Phone:904-726-9901
Practice Address - Fax:904-726-9987
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3024213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU88061Medicare UPIN
21698DMedicare PIN
65770ZMedicare PIN