Healthcare Provider Details

I. General information

NPI: 1003159005
Provider Name (Legal Business Name): ALAN ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 07/21/2022
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

211 NE 54TH ST STE 201
KANSAS CITY MO
64118-4330
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-7273
  • Fax: 816-271-7376
Mailing address:
  • Phone: 816-453-6777
  • Fax: 816-454-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number007306
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036139810
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2020028558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: