Individual
ROBERT PATRICK ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1600 DELTA WATERS RD STE 107, MEDFORD, OR 97504-9114
(541) 858-2515
(541) 858-2514
Mailing address
815 N CENTRAL AVE STE C, MEDFORD, OR 97501-5873
(541) 734-9030
(541) 734-9885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02001534
IN
207Q00000X
Family Medicine Physician
Primary
DO220338
OR
207QS0010X
Sports Medicine (Family Medicine) Physician
02001534A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000581128
ANTHEM PIN
IN
01
—
02001534
IN LICENSE
IN
01
—
1225327984
GROUP NPI
IN
05
—
500838253
—
OR
01
—
90001186
BC IL
IN
01
—
DO220338
OREGON MEDICAL LICENSE
OR
01
—
M100047140
MEDICARE GROUP PTAN
IN
Enumeration date
08/29/2005
Last updated
09/09/2024
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