Individual
BRUCE J ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1072 N LIBERTY ST, SUITE 303, BOISE, ID 83704-2800
(208) 367-4035
(208) 367-7111
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M-7767
ID
207T00000X
Neurological Surgery Physician
M7767
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026334
REGENCE BLUE SHIELD
ID
01
—
134024
OMAP
OR
01
—
145403
WA DEPARTMENT OF LABOR
WA
01
—
185529500
US DEPARTMENT OF LABOR
—
01
—
72504
BLUE CROSS OF IDAHO
—
05
—
805457400
—
ID
05
—
807732500
—
ID
01
—
8J703
BLUE CROSS OF IDAHO GROUP
ID
Enumeration date
08/05/2006
Last updated
02/17/2023
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