Provider Demographics
NPI:1992879159
Name:ANDERSON, HARRY JAMES JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JAMES
Last Name:ANDERSON
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 EAST CHEYENNE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3757
Mailing Address - Country:US
Mailing Address - Phone:719-576-7337
Mailing Address - Fax:719-576-7922
Practice Address - Street 1:190 EAST CHEYENNE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3757
Practice Address - Country:US
Practice Address - Phone:719-576-7337
Practice Address - Fax:719-576-7922
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21329208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01213297Medicaid
CO21329OtherCOLO MEDICAL LICENSE
CO03441OtherCO PROVIDER
AA2576544OtherDEA