Individual
MR. WAYNE L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1213 15TH AVE W, SUITE 200, WILLISTON, ND 58801
(701) 572-4003
(701) 572-4007
Mailing address
1213 15TH AVE W, SUITE 200, WILLISTON, ND 58801
(701) 572-4003
(701) 572-4007
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4768
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0040157
—
MT
05
—
17987
—
ND
01
—
20537
BLUE CROSS
ND
Enumeration date
09/16/2006
Last updated
10/24/2012
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