Healthcare Provider Details

I. General information

NPI: 1942434436
Provider Name (Legal Business Name): JEFFREY ROSS ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 22ND AVE E
ALEXANDRIA MN
56308-4652
US

IV. Provider business mailing address

804 23RD ST S
SARTELL MN
56377-4705
US

V. Phone/Fax

Practice location:
  • Phone: 320-219-7611
  • Fax: 320-219-7612
Mailing address:
  • Phone: 320-230-7788
  • Fax: 320-230-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number57685
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: