Active NPI
Douglas Jefferson Anderson, M. D.
- Internal Medicine Physician
- Titusville, FL
National Provider Identifier
1699701466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME0052042
- Practice address
- 500 N Washington Ave
Suite 208
Titusville, FL 32796-2759 - Phone
- (321) 269-3808
- Fax
- (321) 267-9156
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME0052042 | FL | Primary |
Addresses
Primary practice location
500 N Washington Ave
Suite 208
Titusville, FL 32796-2759
Mailing address
2621 Toups TRL
Titusville, FL 32780-6754
Phone (321) 383-8484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0052042 | FL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1699701466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2621 TOUPS TRL",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327806754",
"telephone_number": "321-383-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N WASHINGTON AVE",
"address_2": "SUITE 208",
"city": "TITUSVILLE",
"state": "FL",
"postal_code": "327962759",
"telephone_number": "321-269-3808",
"fax_number": "321-267-9156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "DOUGLAS",
"middle_name": "JEFFERSON",
"name_prefix": "Dr.",
"credential": "M. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME0052042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Titusville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.