Healthcare Provider Details

I. General information

NPI: 1356334965
Provider Name (Legal Business Name): REAGAN B ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 SCARBOROUGH DR SUITE 225
COLORADO SPRINGS CO
80920-7586
US

IV. Provider business mailing address

8580 SCARBOROUGH DR SUITE 225
COLORADO SPRINGS CO
80920-7586
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-5400
  • Fax: 719-531-9545
Mailing address:
  • Phone: 719-531-5400
  • Fax: 719-531-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number48132
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberDR.0048132
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: