Individual
DR. DOUGLAS KEN ANDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1720
(208) 239-1726
Mailing address
10109 E. 79TH STREET, TULSA, OK 74133
(918) 286-5000
(918) 249-7514
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6352
OK
Other
Enumeration date
05/02/2014
Last updated
10/27/2022
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