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General NPI Number Information
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NPI Number | 1477655090
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Entity Type | Individual
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Provider Name | CHARLES CRAGIN ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 3 SUPERIOR DR STE 350
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City | SUPERIOR
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State | CO
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Zip | 80027-8722
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Country | US
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Telephone | 303-666-4343
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Fax | 303-666-6741
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Provider Business Mailing Address
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Address Line | 10200 GRAND CENTRAL AVE STE 220
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4366
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Country | US
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Telephone |
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 40017
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | DR.0040017
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License Number State | CO
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