Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 60649 | MN |
NPI | 1447423603 |
---|---|
Provider Name | Anthony Wyatt Anderson |
First Address | Saint Paul, MN 55102-2592 |
Second Address | Saint Paul, MN 55102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 05/06/2018 |