Healthcare Provider Details

I. General information

NPI: 1588656243
Provider Name (Legal Business Name): ROBERT JOHN ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10032 N WALLACE AVE
KANSAS CITY MO
64157-7856
US

IV. Provider business mailing address

3810 NORTHDALE BLVD STE 150
TAMPA FL
33624-1871
US

V. Phone/Fax

Practice location:
  • Phone: 515-291-3561
  • Fax:
Mailing address:
  • Phone: 813-961-1331
  • Fax: 888-850-8316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number04-35274
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2011004796
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberDR.0069784
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: