Healthcare Provider Details

I. General information

NPI: 1578556155
Provider Name (Legal Business Name): ROBERT PATRICK ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DELTA WATERS RD STE 107
MEDFORD OR
97504-9114
US

IV. Provider business mailing address

815 N CENTRAL AVE STE C
MEDFORD OR
97501-5873
US

V. Phone/Fax

Practice location:
  • Phone: 541-858-2515
  • Fax: 541-858-2514
Mailing address:
  • Phone: 541-734-9030
  • Fax: 541-734-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number02001534A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO220338
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001534
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: