Bruce J Andersen
Neurosurgeon
1072 N Liberty St Suite 303
Boise
, Idaho 83704-2800
Bruce J Andersen
Neurosurgeon
1072 N Liberty St Suite 303
Boise
, Idaho 83704-2800
(208) 367-5180
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About
Features
Specialties
- Neurosurgeon
Languages spoken
- English
Location
First Address
- Bruce J Andersen
- 3340 E Goldstone Way
- Meridian, ID
- Zip : 83642-1026
- Fax : (208) 367-5180
- Phone : (208) 367-5170
Second Address
- Bruce J Andersen
- 1072 N Liberty St Suite 303
- Boise, ID
- Zip : 83704-2800
- Fax : (208) 367-7111
- Phone : (208) 367-4035
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207T00000X | Neurosurgeon | M-7767 | ID |
| N | 207T00000X | Neurosurgeon | M7767 | ID |
National Provider Identifier
| NPI | 1063420792 |
|---|---|
| Provider Name | Bruce J Andersen |
| First Address | Meridian, ID 83642-1026 |
| Second Address | Boise, ID 83704-2800 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/08/2006 |
| Last Update Date | 12/05/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000010026334 | REGENCE BLUE SHIELD (01) | ID |
| 134024 | OMAP (01) | OR |
| 145403 | WA DEPARTMENT OF LABOR (01) | WA |
| 185529500 | US DEPARTMENT OF LABOR (01) | |
| 72504 | BLUE CROSS OF IDAHO (01) | |
| 805457400 | (05) | ID |
| 807732500 | (05) | ID |
| 8J703 | BLUE CROSS OF IDAHO GROUP (01) | ID |
| F21975 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.