Individual
LARRY ROGER ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
507 E 16TH ST, STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
(620) 326-7086
Mailing address
507 E 16TH ST, STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
(620) 326-7086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15917
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080048663
RR MEDICARE
KS
05
—
100083720A
—
KS
01
—
CS5682
GROUP RAILROAD
—
Enumeration date
11/08/2005
Last updated
05/08/2020
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