Provider Demographics
NPI:1053384362
Name:ANDERSON, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:DEPT 888025
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8025
Mailing Address - Country:US
Mailing Address - Phone:512-583-0205
Mailing Address - Fax:512-583-2001
Practice Address - Street 1:908 WEST 4TH NORTH STREET
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3894
Practice Address - Country:US
Practice Address - Phone:423-522-5000
Practice Address - Fax:423-522-4901
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD356662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN920006665OtherRAILROAD MEDICARE
TN3867352Medicaid
TN3867352Medicare PIN