Healthcare Provider Details

I. General information

NPI: 1245465210
Provider Name (Legal Business Name): PEDER L ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD STE 2200
BOZEMAN MT
59715-6915
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5700
  • Fax:
Mailing address:
  • Phone: 406-414-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15958
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: