Provider Demographics
NPI:1699931121
Name:ROBERT F ANDERSON D.P.M.,M.D.,P.A.
Entity type:Organization
Organization Name:ROBERT F ANDERSON D.P.M.,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM/MD
Authorized Official - Phone:207-262-9562
Mailing Address - Street 1:900 BROADWAY
Mailing Address - Street 2:BUILDING#1
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1900
Mailing Address - Country:US
Mailing Address - Phone:207-262-9562
Mailing Address - Fax:207-262-9564
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:BUILDING#1
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-262-9562
Practice Address - Fax:207-262-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD 1028213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty