Healthcare Provider Details

I. General information

NPI: 1750465472
Provider Name (Legal Business Name): BETH A. ANDERSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CLINCH AVE STE 120
KNOXVILLE TN
37916-2288
US

IV. Provider business mailing address

2219 BROADWAY E
SEATTLE WA
98102-4135
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-7290
  • Fax:
Mailing address:
  • Phone: 206-499-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberWA00034550
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number5961565
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD223301
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG186314
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00034550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: