Provider Demographics
NPI:1487934865
Name:ANDERSON, JEFFREY DREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DREW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:J.
Other - Middle Name:DREW
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 2000 1638 OWEN DRIVE
Mailing Address - Street 2:CAPE FEAR VALLEY MEDICAL CENTER EMERGENCY DEPARTMENT
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2000
Mailing Address - Country:US
Mailing Address - Phone:910-615-8000
Mailing Address - Fax:910-321-6250
Practice Address - Street 1:1638 OWEN DRIVE
Practice Address - Street 2:CAPE FEAR VALLEY MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2000
Practice Address - Country:US
Practice Address - Phone:910-615-8000
Practice Address - Fax:910-321-6250
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000768363AM0700X
PAMA054881363AM0700X
NC0010-04177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical