Healthcare Provider Details

I. General information

NPI: 1417058496
Provider Name (Legal Business Name): BRIAN ALEXANDER ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 S 88TH ST
LOUISVILLE CO
80027-9716
US

IV. Provider business mailing address

2255 S 88TH ST
LOUISVILLE CO
80027-9716
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-2095
  • Fax: 303-666-1801
Mailing address:
  • Phone: 303-666-2095
  • Fax: 303-666-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number41499
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: