Individual
BRAD C ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8720
(701) 234-8779
Mailing address
PO BOX 2010, FARGO, ND 58122-0605
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
46
ND
213E00000X
Podiatrist
673
MN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
46
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11706
—
ND
Enumeration date
07/18/2006
Last updated
04/06/2022
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