Provider Demographics
NPI:1063514495
Name:ANDERSON, KANE LIBRUM (MD)
Entity type:Individual
Prefix:DR
First Name:KANE
Middle Name:LIBRUM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MERCADO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7306
Mailing Address - Country:US
Mailing Address - Phone:970-247-5362
Mailing Address - Fax:970-259-6045
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7306
Practice Address - Country:US
Practice Address - Phone:970-247-5362
Practice Address - Fax:970-259-6045
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO47733207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO305752OtherMEDICARE PTAN