Individual
DR. MICKEY DALE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
118 PATRIOT DR, SUITE 203, BARDSTOWN, KY 40004-9093
(502) 348-5588
(502) 348-1046
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7840
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20844
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64208440
—
KY
Enumeration date
02/10/2006
Last updated
05/06/2019
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