Provider Demographics
NPI:1730162835
Name:ANDERSON, CARRIE E (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4944
Mailing Address - Country:US
Mailing Address - Phone:850-208-1142
Mailing Address - Fax:850-732-8666
Practice Address - Street 1:311 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4944
Practice Address - Country:US
Practice Address - Phone:850-208-1142
Practice Address - Fax:850-732-8666
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200238850AMedicaid
H30284Medicare UPIN
IN200238850AMedicaid