Jack W. Anderson, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD.16671 Issued in AL

Practice address

470 Taylor Rd
Montgomery, AL 36117-3563

Phone

(334) 226-4048

Fax

(334) 323-5675

NPI assigned

Mar 7, 2006

Last updated

Sep 26, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pain Treatment Centers of Alabama, PC

  • Interventional Pain Medicine Physician
  • Montgomery, AL
  • NPI 1467866624
  Authorized official Same address or phone
• The Center for Pain of Montgomery LLC

  • Interventional Pain Medicine Physician
  • Montgomery, AL
  • NPI 1588710289
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1811964000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 OLD ROCKY RIDGE ROAD",
            "address_2": "SUITE 106",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352167251",
            "telephone_number": "205-989-1080",
            "fax_number": "205-989-1087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 TAYLOR RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173563",
            "telephone_number": "334-226-4048",
            "fax_number": "334-323-5675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACK",
        "middle_name": "W.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-07",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": "MD.16671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "050071018",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "510-45874",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214426",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol L Anders, CRNP
• Anderson-Robertson DMD PC (Montgomery Dentistry)
• Amber Anderson
• Amy M. Anderson, D.M.D.
• Candyce Anderson, M.S., A.L.C.
• Jacob Anderson, DO
• Jameelah Anderson, RN
• James Noble Anderson Jr., MD
• Kathryn Kollefrath Anderson, PHARM.D.
• Krisan T Anderson, PHARMD

• Anesthesiology Physician in Montgomery, AL
• Providers in Montgomery, AL by specialty
• Anesthesiology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.