MEDICARE: GARY D. ANDERSON MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	22274	WI

General Provider Information

NPI Number	:	1447243175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY D. ANDERSON MD

Provider Business Mailing Address
First Line	:	6219 EXCHANGE ST
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9241
Country	:	US
Telephone Number	:	608-838-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	6219 EXCHANGE ST
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9241
Country	:	US
Telephone Number	:	608-838-4021
Fax Number	:

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	11/17/2022

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