Provider Demographics
NPI:1396781530
Name:ANDERSON, RICHARD MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:MICHAEL
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 COVEY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-791-1907
Mailing Address - Fax:615-595-0742
Practice Address - Street 1:100 COVEY DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-791-1907
Practice Address - Fax:615-595-0742
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN406012177AOtherMEDICARE RAILROAD
TN2008280OtherBCBS
TN3158283Medicaid
TN406012177AOtherMEDICARE RAILROAD
TN3158283Medicaid