Provider Demographics
NPI:1982792198
Name:ANDERSON, PERCY L JR (DPM, CWS, CMET)
Entity Type:Individual
Prefix:DR
First Name:PERCY
Middle Name:L
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:DPM, CWS, CMET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1533
Mailing Address - Street 2:SUITE 434
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1533
Mailing Address - Country:US
Mailing Address - Phone:601-502-1100
Mailing Address - Fax:601-502-0111
Practice Address - Street 1:1815 HOSPITAL DR
Practice Address - Street 2:SUITE 434
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3425
Practice Address - Country:US
Practice Address - Phone:601-502-1100
Practice Address - Fax:601-502-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80107213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640813898OtherUNITED HEALTH CARE
MS640813898OtherAETNA
MS640813898OtherTRICARE
MS05984200Medicaid
MS640813898OtherCIGNA
MS05984200Medicaid
MS640813898OtherCIGNA