Provider Demographics
NPI:1194848697
Name:ANDERSON, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 HARLOW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1341
Mailing Address - Country:US
Mailing Address - Phone:541-302-7771
Mailing Address - Fax:
Practice Address - Street 1:445 HARLOW RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1341
Practice Address - Country:US
Practice Address - Phone:541-302-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2309830-12052085R0202X
WAMD610220672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology