Anderson, Marcus Walter

Anderson, Marcus Walter is an individual health care provider with primary practice located at 400 Health Park Blvd , St Augustine FL 32086-5784. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Forensic Psychiatry. Allopathic & Osteopathic Physicians / Forensic Psychiatry is his primary health care specialty. Anderson, Marcus Walter can be contacted via phone (904) 819-4565.

Contact Information

Primary practice address
400 Health Park Blvd St Augustine FL 32086-5784
Phone: (904) 819-4565
Fax: (904) 819-4999
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X TRN10998 Florida
Allopathic & Osteopathic Physicians / Forensic Psychiatry 2084F0202X ME105840 Florida

Profile Details

NPI number 1801094578
LBN Legal business name Anderson, Marcus Walter
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 4th, 2007
Last updated Feb 12th, 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 1801094578 NPPES
Florida MEDICAID 116379300
Florida Other 14N4N

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