Healthcare Provider Details

I. General information

NPI: 1346289550
Provider Name (Legal Business Name): THOMAS MICHAEL ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE SUITE 5300
DENVER CO
80218-1216
US

IV. Provider business mailing address

6226 S FAIRFAX CT
CENTENNIAL CO
80121-3418
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7440
  • Fax: 303-839-7210
Mailing address:
  • Phone: 303-779-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38907
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: