Provider Demographics
NPI:1871772509
Name:DANIEL R ANDERSON MD PC
Entity type:Organization
Organization Name:DANIEL R ANDERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-883-5501
Mailing Address - Street 1:1101 N JIM DAY RD
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-5200
Mailing Address - Country:US
Mailing Address - Phone:812-883-5501
Mailing Address - Fax:812-883-5513
Practice Address - Street 1:1101 N JIM DAY RD
Practice Address - Street 2:SUITE 107A
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-5200
Practice Address - Country:US
Practice Address - Phone:812-883-5501
Practice Address - Fax:812-883-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN890710Medicare PIN