Phan Tasco Anderson, PA

NPI #1265570105 in Kathleen, Georgia

Provider Information

NPI Number: 1265570105
Entity Type: Individual
Name: Phan Tasco Anderson, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Feb 2, 2007
Last Updated: Jan 18, 2012

Practice Location

Address: 203 GREYTHORNE DR
City: Kathleen
State: Georgia
ZIP Code: 31047-5304
Phone: (719) 337-9392

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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