Healthcare Provider Details

I. General information

NPI: 1104807692
Provider Name (Legal Business Name): DANIEL KENT ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 4TH AVE MAB 3RD FLOOR
GRINNELL IA
50112-1898
US

IV. Provider business mailing address

210 4TH AVE MAB 3RD FLOOR
GRINNELL IA
50112-1898
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-2382
  • Fax: 641-236-2907
Mailing address:
  • Phone: 641-236-2382
  • Fax: 641-236-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27178
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: