Organization
BRUCE J ANDERSEN MD PHD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE J ANDERSEN MD PHD (OWNER)
(208) 367-3500
Entity
Organization
Contact information
Practice address
6140 CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 367-3500
(208) 367-2968
Mailing address
6140 CURTISIAN AVE, SUITE 400, BOISE, ID 83704-8880
(208) 367-3500
(208) 367-2968
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
M7767
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026334
REGENCE BLUE SHIELD
ID
01
—
134024
OMAP
ID
01
—
145403
WA DEPARTMENT OF LABOR
WA
01
—
185529500
US DEPARTMENT OF LABOR
—
01
—
72504
BLUE CROSS OF IDAHO
ID
05
—
805457400
—
ID
05
—
87732500
—
ID
01
—
8J703
BLUE CROSS OF IDAHO GROUP
ID
Enumeration date
08/05/2006
Last updated
03/04/2011
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