Provider Demographics
NPI:1053351759
Name:ANDERSON, FREDERICK W (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 SW 108TH AVE
Mailing Address - Street 2:100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2555
Mailing Address - Country:US
Mailing Address - Phone:305-348-0254
Mailing Address - Fax:305-348-4261
Practice Address - Street 1:800 SW 108TH AVE
Practice Address - Street 2:100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2555
Practice Address - Country:US
Practice Address - Phone:305-348-0254
Practice Address - Fax:305-348-4261
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270541900Medicaid
FLBA8534869OtherDEA NUMBER
FLI19790Medicare UPIN