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NPI Code Detail

MEDICARE: GARY E ANDERSON DO

MEDICARE: GARY E ANDERSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01552IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1IA0104OTHERJOHN DEERE HEALTH PLAN
24796890009OTHERDMERC
3034792OTHERHEALTH ALLIANCE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
520100OTHERIOWA HEALTH SOLUTIONS
640197OTHERIAWELLMARK BC/BS

General Provider Information

NPI Number : 1205831120
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY E ANDERSON DO
Provider Business Mailing Address
First Line : 865 LINCOLN RD
Second Line : STE L10
City : BETTENDORF
State : IA
Zip : 52722-4159
Country : US
Telephone Number : 563-355-9191
Fax Number : 563-355-3419
Provider Business Practice Location Address
First Line : 210 W 53RD ST
Second Line :
City : DAVENPORT
State : IA
Zip : 52806-2251
Country : US
Telephone Number : 563-386-3436
Fax Number : 563-386-3211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 07/09/2007

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Directions to “ GARY E ANDERSON DO” Practice Location

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