Provider Demographics
NPI:1003159005
Name:ANDERSON, ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:211 NE 54TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4330
Mailing Address - Country:US
Mailing Address - Phone:816-453-6777
Mailing Address - Fax:816-454-3601
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-7273
Practice Address - Fax:816-271-7376
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0073062084P0800X
IL0361398102084P0800X
MO20200285582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry