MEDICARE: BRYAN J ANDERSON MD PC

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	208600000X	Surgery Physician	M7735	ID

Other Identifiers

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

General Provider Information

NPI Number	:	1942270251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN J ANDERSON MD PC

Provider Business Mailing Address
First Line	:	1072 N LIBERTY ST
Second Line	:	#201
City	:	BOISE
State	:	ID
Zip	:	83704-8706
Country	:	US
Telephone Number	:	208-377-2273
Fax Number	:	208-367-3059

Provider Business Practice Location Address
First Line	:	1072 N LIBERTY ST
Second Line	:	#201
City	:	BOISE
State	:	ID
Zip	:	83704-8706
Country	:	US
Telephone Number	:	208-377-2273
Fax Number	:	208-367-3059

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRYAN J ANDERSON
Credential	:	MD
Telephone Number	:	208-377-2273

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/07/2012

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