Individual
KENNETH R ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1200 N 7TH ST, CHARITON, IA 50049-1210
(641) 774-8103
(641) 774-8087
Mailing address
1200 N 7TH ST, CHARITON, IA 50049-1210
(641) 774-8103
(641) 774-8087
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01931
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110153091
TRAVELERS MEDICARE
IA
01
—
1275513756
WELLMARK
IA
05
—
1275513756
—
IA
01
—
40870
BCBS
IA
01
—
40871
BCBS
IA
05
—
4193557
—
IA
05
—
5193557
—
IA
Enumeration date
01/19/2006
Last updated
02/08/2012
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