Healthcare Provider Details

I. General information

NPI: 1467433979
Provider Name (Legal Business Name): TOM ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 9TH ST #B
CODY WY
82414-3441
US

IV. Provider business mailing address

PO BOX 30976
BILLINGS MT
59107-0976
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-5622
  • Fax: 307-587-5657
Mailing address:
  • Phone: 406-238-6290
  • Fax: 406-238-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9660
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number6512A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: