Individual
DR. GREGORY S ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
HWY 1 HOSPITAL DRIVE, BOX 497, RED LAKE, MN 56671-0497
(218) 679-3912
(218) 679-0181
Mailing address
PO BOX 497, REDLAKE, MN 56671-0497
(218) 679-3912
(218) 679-0181
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
32831
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34G00AN
BC/BS OF MN
MN
05
—
476753500
—
MN
Enumeration date
07/05/2006
Last updated
02/21/2008
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