Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 36539 | MO |
Y | 207RI0011X | Interventional Cardiology | 36539 | MO |
NPI | 1073557922 |
---|---|
Provider Name | Mark D Anderson |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107049 | BLUE CROSS/BLUE SHIELD (01) | |
201523107 | (05) | MO |
203008701 | (05) | MO |
F30468 | (02) |