Individual
MARK ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD LP
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, PO BOX 800, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1721
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114910
—
MN
01
—
40D59AN
BLUE CROSS
MN
05
—
40D59AN
—
MN
01
—
7314
AVERA
MN
01
—
862668
ARAZ
MN
01
—
A031
CHAMPUS
MN
01
—
HP18890
HEALTHPARTNERS
MN
01
—
MH9041009757
PREFERREDONE
MN
Enumeration date
12/09/2005
Last updated
07/09/2007
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