Healthcare Provider Details

I. General information

NPI: 1518965391
Provider Name (Legal Business Name): ROBERT LEROY ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N KANSAS AVE SUITE 205
HASTINGS NE
68901-4453
US

IV. Provider business mailing address

715 N KANSAS AVE SUITE 205
HASTINGS NE
68901-4453
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-4521
  • Fax:
Mailing address:
  • Phone: 402-463-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15995
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: