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General NPI Number Information
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NPI Number | 1952698961
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Entity Type | Organization
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Legal Business Name | MATTHEW ANDERSON MD PC
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 2918 HAMILTON BLVD BLDG D, STE 102
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City | SIOUX CITY
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State | IA
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Zip | 51104-2414
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Country | US
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Telephone | 712-226-4263
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Fax | 716-226-4870
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Provider Business Mailing Address
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Address Line | 2918 HAMILTON BLVD BLDG D, STE 102
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City | SIOUX CITY
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State | IA
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Zip | 51104-2414
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Country | US
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Telephone | 712-226-4263
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Fax | 716-226-4870
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW C ANDERSON
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Credential | MD
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Telephone | 712-226-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 38341
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License Number State | IA
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