Healthcare Provider Details

I. General information

NPI: 1326364324
Provider Name (Legal Business Name): MALCOLM ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HIGH ST
DENVER CO
80205-5555
US

IV. Provider business mailing address

2001 N HIGH ST
DENVER CO
80205-5555
US

V. Phone/Fax

Practice location:
  • Phone: 720-500-4322
  • Fax:
Mailing address:
  • Phone: 720-754-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberDR.0052387
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: