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General NPI Number Information
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NPI Number | 1093200123
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Entity Type | Individual
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Provider Name | ANDALIB DANANDEH MD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 300 W OTTLEY AVE
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City | FRUITA
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State | CO
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Zip | 81521-2118
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Country | US
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Telephone | 970-858-2211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | FRUITA
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State | CO
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Zip | 81521-0130
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Country | US
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Telephone | 970-858-2211
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Fax | 970-858-2208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 326218
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0074372
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 65198
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License Number State | TN
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