Provider Demographics
NPI:1104047695
Name:ANDERSEN, JAMES L (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:805 CRYSTAL BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839
Mailing Address - Country:US
Mailing Address - Phone:863-287-3485
Mailing Address - Fax:863-683-9180
Practice Address - Street 1:805 CRYSTAL BEACH ROAD
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:FL
Practice Address - Zip Code:33839
Practice Address - Country:US
Practice Address - Phone:863-287-3485
Practice Address - Fax:863-683-9180
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00249312083A0300X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic