Individual
DR. BRADLEY MYREN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122
Mailing address
2055 15TH ST N, SAINT CLOUD, MN 56303-1747
(320) 251-1432
(320) 251-7122
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
43592
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08-01106
MEDICA
MN
01
—
441T6AN
BLUE CROSS
MN
05
—
527444300
—
MN
01
—
P00134021
RAILROAD MEDICARE
—
Enumeration date
10/07/2005
Last updated
02/20/2012
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