Healthcare Provider Details

I. General information

NPI: 1174937072
Provider Name (Legal Business Name): JOHN ERICK ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 E GEDDES AVE STE 300
ENGLEWOOD CO
80112-3895
US

IV. Provider business mailing address

10800 E GEDDES AVE STE 300
ENGLEWOOD CO
80112-3895
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-9190
  • Fax: 720-874-4462
Mailing address:
  • Phone: 303-761-9190
  • Fax: 720-874-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDOS-2201
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2419
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberPENDING
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21795
License Number StateND
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0065499
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number008029
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number05-44958
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125-065537
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number008029
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: