Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 23462 | MN |
N | 2080P0208X | Pediatric Infectious Diseases | 23462 | MN |
NPI | 1417920430 |
---|---|
Provider Name | Richard D Andersen |
First Address | Roseville, MN 55113 |
Second Address | St Paul, MN 55102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02032 | (02) |