Anderson, Jesse

Anderson, Jesse is an individual health care provider with primary practice located at 2401 Godwin Blvd Ste 1 , Suffolk VA 23434-8178. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Anderson, Jesse can be contacted via phone (757) 625-2962.

Contact Information

Primary practice address
2401 Godwin Blvd Ste 1 Suffolk VA 23434-8178
Phone: (757) 625-2962
Fax: (757) 627-9861
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 0103000709 Virginia

Profile Details

NPI number 1770583080
LBN Legal business name Anderson, Jesse
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2005
Last updated Mar 7th, 2023 - about 2 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 1770583080 NPPES
Virginia Other 62841 OPTIMA
Virginia Other 282441 OPTIMA
Virginia Other 0103000709 OPTIMA

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