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DR. LUIS M ANDERSON M.D.
>> Pediatrics >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1649337635
Individual Registrant:DR. LUIS M ANDERSON M.D.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
3670 US 1 S STE 300B SAINT AUGUSTINE, FL 32086-6354 US
Tel: 904-479-9501 Fax: 904-217-0524
Tel: 904-479-9501 Fax: 904-217-0524
Contact information for business:
3670 US 1 S STE 300B SAINT AUGUSTINE, FL 32086-6354 US
Tel: 904-479-9501 Fax: 904-217-0524
Tel: 904-479-9501 Fax: 904-217-0524
Registration Information:
NPI: 1649337635
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208000000X | Allopathic & Osteopathic Physicians Pediatrics | FL | ME0089595 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 269304600 | FL | 05 | |
| AETNA | 7201378 | FL | 01 |
| TAX ID | 650598984 | FL | 01 |
| BCBS | 37560 | FL | 01 |
