Individual
COREY LEE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7220 S HIGHWAY 16, RAPID CITY, SD 57702-8708
(605) 341-1414
Mailing address
PO BOX 6850, RAPID CITY, SD 57709-6850
(605) 737-9144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0802
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2003422
—
SD
Enumeration date
12/06/2011
Last updated
01/16/2020
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