Provider Demographics
NPI:1104112705
Name:ANDERSON, DANIEL MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MATTHEW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E EMORY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3567
Mailing Address - Country:US
Mailing Address - Phone:865-859-7377
Mailing Address - Fax:865-859-7378
Practice Address - Street 1:603 E EMORY RD STE 105
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3567
Practice Address - Country:US
Practice Address - Phone:865-859-7377
Practice Address - Fax:865-859-7378
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ020506Medicaid