Individual
BRUCE A ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
109 RAILROAD AVE, LAS VEGAS, NM 87701
(505) 425-9491
(505) 454-8171
Mailing address
109 RAILROAD AVE, LAS VEGAS, NM 87701
(505) 425-9491
(505) 454-8171
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
163
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005351
BCBS
—
01
—
10478
PRESBYTERIAN HP
—
Enumeration date
10/03/2006
Last updated
05/07/2008
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