Provider Demographics
NPI:1982806857
Name:JANET ANDERSON MD PA
Entity type:Organization
Organization Name:JANET ANDERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-794-7791
Mailing Address - Street 1:777 37TH ST STE C105
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7301
Mailing Address - Country:US
Mailing Address - Phone:772-794-7791
Mailing Address - Fax:772-794-7794
Practice Address - Street 1:777 37TH ST STE C105
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7301
Practice Address - Country:US
Practice Address - Phone:772-794-7791
Practice Address - Fax:772-794-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061810207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE53602Medicare UPIN
FLK2308AMedicare PIN