Healthcare Provider Details

I. General information

NPI: 1639417983
Provider Name (Legal Business Name): DOUGLAS ALAN ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11942 N 95TH ST
SCOTTSDALE AZ
85260-7133
US

IV. Provider business mailing address

11942 N 95TH ST
SCOTTSDALE AZ
85260-7133
US

V. Phone/Fax

Practice location:
  • Phone: 480-483-7772
  • Fax: 480-907-7036
Mailing address:
  • Phone: 480-483-7772
  • Fax: 480-907-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: