Provider Demographics
NPI:1215924006
Name:ANDERSON, PAUL DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4342
Mailing Address - Country:US
Mailing Address - Phone:712-262-1808
Mailing Address - Fax:712-262-5532
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4342
Practice Address - Country:US
Practice Address - Phone:712-262-1808
Practice Address - Fax:712-262-5532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA019292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2015115Medicaid
IA23275Medicare ID - Type UnspecifiedIA MEDICARE PROVIDER NO.
IA2015115Medicaid