Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 28119 | NC |
N | 207X00000X | Orthopaedic Surgeon | 29236-20 | WI |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 28119 | NC |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 29236-20 | WI |
NPI | 1326021288 |
---|---|
Provider Name | Dr. Robert Bentley Anderson |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54304-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100069495 | (05) | WI |
1326021288 | (05) | NC |