MEDICARE: DR. CRAIG ALLAN ANDERSON D.O.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	3083	OK

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1184629487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ALLAN ANDERSON D.O.

Provider Business Mailing Address
First Line	:	1120 S UTICA AVE
Second Line	:	STE 2123
City	:	TULSA
State	:	OK
Zip	:	74104-4012
Country	:	US
Telephone Number	:	918-579-5402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 S UTICA AVE
Second Line	:	STE 2123
City	:	TULSA
State	:	OK
Zip	:	74104-4012
Country	:	US
Telephone Number	:	918-579-5402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/02/2015

1120 S UTICA AVE STE 100
TULSA, OK
74104-4012

Practice Phone: 918-579-3826
Practice Fax: 918-579-1262