Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 48132 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | DR.0048132 | CO |
NPI | 1356334965 |
---|---|
Provider Name | Mr. Reagan B Anderson |
First Address | Colorado Springs, CO 80920-7586 |
Second Address | Colorado Springs, CO 80920-7586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 03/09/2020 |