Healthcare Provider Details

I. General information

NPI: 1295736700
Provider Name (Legal Business Name): ROBERT SCOTT ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 RICHMOND DR
FORT COLLINS CO
80526-5995
US

IV. Provider business mailing address

1300 RIVERSIDE AVE STE 102
FORT COLLINS CO
80524-4353
US

V. Phone/Fax

Practice location:
  • Phone: 970-204-0300
  • Fax:
Mailing address:
  • Phone: 970-224-1670
  • Fax: 970-495-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34326
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: