Healthcare Provider Details

I. General information

NPI: 1831208685
Provider Name (Legal Business Name): ROBERT CLIFTON ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WILLOW LAKE BLVD SUITE 240
SAINT PAUL MN
55110-5131
US

IV. Provider business mailing address

60 PLATO BLVD E SUITE 270
SAINT PAUL MN
55107-1827
US

V. Phone/Fax

Practice location:
  • Phone: 651-770-0110
  • Fax: 651-770-0134
Mailing address:
  • Phone: 651-209-1600
  • Fax: 651-291-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number45910
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: