Healthcare Provider Details

I. General information

NPI: 1326011743
Provider Name (Legal Business Name): THOMAS S ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 CHURCHILL ST W
STILLWATER MN
55082-6605
US

IV. Provider business mailing address

1500 CURVE CREST BLVD W
STILLWATER MN
55082-6040
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-5330
  • Fax: 651-439-4528
Mailing address:
  • Phone: 651-439-1234
  • Fax: 651-439-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40536
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43474
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number40536
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: