Healthcare Provider Details

I. General information

NPI: 1982700753
Provider Name (Legal Business Name): MATTHEW PAUL ANDERSON RRT,RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

605 5TH ST NW
LITTLE FALLS MN
56345-1238
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-6480
  • Fax: 320-255-6482
Mailing address:
  • Phone: 218-591-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number2548
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: