Provider Demographics
NPI:1033080411
Name:ANDERSON, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 AVENIDA DEL MARE
Mailing Address - Street 2:
Mailing Address - City:SIESTA KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1914
Mailing Address - Country:US
Mailing Address - Phone:941-378-9966
Mailing Address - Fax:
Practice Address - Street 1:5632 BEE RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1506
Practice Address - Country:US
Practice Address - Phone:941-378-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155881202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine