Healthcare Provider Details

I. General information

NPI: 1497783955
Provider Name (Legal Business Name): BRUCE JOHN ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

IV. Provider business mailing address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-8400
  • Fax: 612-677-3321
Mailing address:
  • Phone: 612-625-8400
  • Fax: 621-677-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32095
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: