Individual
DR. BLAKE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1344 RED OAK PLANTATION DR, BALLWIN, MO 63021-7346
(314) 591-3417
Mailing address
1344 RED OAK PLANTATION DR, BALLWIN, MO 63021-7346
(314) 591-3417
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2009013290
MO
207Q00000X
Family Medicine Physician
Primary
2009013290
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-13048
MEDICA
MN
01
—
1019018
ARAZ
MN
05
—
1093798134
—
MO
05
—
150459
—
MN
05
—
16690100
—
MN
01
—
21955
SIOUX VALLEY HEALTH PLANS
MN
01
—
67Q18AN
BLUE CROSS/BLUE PLUS
MN
01
—
7291
AVERA
MN
01
—
A035
CHAMPUS
MN
01
—
HP30702
HEALTHPARTNERS
MN
01
—
MH9041023739
PREFERRED ONE
MN
Enumeration date
11/22/2005
Last updated
04/08/2014
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