Provider Demographics
NPI:1942592498
Name:ANDERSON, EDWARD JERMAINE (MD, PT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JERMAINE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8650 WINCHESTER ST
Mailing Address - Street 2:2202
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-8109
Mailing Address - Country:US
Mailing Address - Phone:913-709-5732
Mailing Address - Fax:
Practice Address - Street 1:33600 W 85TH ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018-8118
Practice Address - Country:US
Practice Address - Phone:913-583-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist