Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 26362 | MN |
NPI | 1124089677 |
---|---|
Provider Name | Glen F Anderson |
First Address | Minneapolis, MN 55404-4289 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
932303100 | (05) | MN |
A95114 | (02) | MN |