Individual
MARK D ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 875-3000
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
36539
MO
207RI0011X
Interventional Cardiology Physician
Primary
36539
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107049
BLUE CROSS/BLUE SHIELD
—
05
—
201523107
—
MO
05
—
203008701
—
MO
Enumeration date
06/15/2006
Last updated
12/27/2018
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