Individual
DR. JOSEPH M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 535-4130
(208) 535-4125
Mailing address
PO BOX 1647, 2860 CHANNING WAY SUITE 115, IDAHO FALLS, ID 83403-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0-102
ID
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
0-102
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003570500
—
ID
01
—
54547
BLUE CROSS ID
ID
Enumeration date
12/29/2005
Last updated
07/31/2012
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