Individual
TRENT D ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
500 W GRANT ST, LAKE CITY, MN 55041-1143
(651) 345-3321
Mailing address
500 W GRANT ST, LAKE CITY, MN 55041-1143
(651) 345-3321
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
55205
MN
207Q00000X
Family Medicine Physician
PERMIT22868
MN
390200000X
Student in an Organized Health Care Education/Training Program
55205
MN
Other
Enumeration date
09/30/2010
Last updated
09/28/2020
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