Individual
EARL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(715) 258-1160
(715) 256-3079
Mailing address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(920) 256-3000
(715) 256-3079
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26741
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000169010
MEDICARE PTAN
WI
05
—
30834600
—
WI
Enumeration date
07/20/2006
Last updated
11/16/2011
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