Provider Demographics
NPI:1194749077
Name:ANDERSON, CRIS J (MD)
Entity type:Individual
Prefix:
First Name:CRIS
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1886
Mailing Address - Country:US
Mailing Address - Phone:308-630-1917
Mailing Address - Fax:308-632-7830
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-630-1398
Practice Address - Fax:308-362-7830
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21548207ZP0102X
MO35782207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE21548OtherSTATE LICENSE
NE34079OtherBCBS (CLASSIC & PREFERRED
MO35782OtherSTATE LICENSE
MO35782OtherSTATE LICENSE
NEH25610Medicare UPIN
NE21548OtherSTATE LICENSE