Healthcare Provider Details

I. General information

NPI: 1659346377
Provider Name (Legal Business Name): MICHAEL WILLIAM ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/23/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 MARMOT DR
RIDGWAY CO
81432-9484
US

IV. Provider business mailing address

642 MARMOT DR
RIDGWAY CO
81432-9484
US

V. Phone/Fax

Practice location:
  • Phone: 303-619-3787
  • Fax:
Mailing address:
  • Phone: 303-619-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37032
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: