Anderson, Jack D

Anderson, Jack D is an individual health care provider with primary practice located at 7030 Pineville Matthews Rd , Charlotte NC 28226-8298. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Anderson, Jack D can be contacted via phone (704) 667-4150.

Contact Information

Primary practice address
7030 Pineville Matthews Rd Charlotte NC 28226-8298
Phone: (704) 667-4150
Fax: (704) 752-7040
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 30586 North Carolina

Profile Details

NPI number 1417976234
LBN Legal business name Anderson, Jack D
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Jun 25th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417976234 NPPES
South Carolina MEDICAID N30586
South Carolina Other 11152
South Carolina MEDICAID 8911152

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