Healthcare Provider Details

I. General information

NPI: 1700841277
Provider Name (Legal Business Name): ROBERT H ANDERSON PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 CHOUTEAU ST
FORT BENTON MT
59442-9003
US

IV. Provider business mailing address

PO BOX 5096
GREAT FALLS MT
59403-5096
US

V. Phone/Fax

Practice location:
  • Phone: 406-622-5485
  • Fax: 406-622-5670
Mailing address:
  • Phone: 406-622-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-289
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number155263
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: