Provider Demographics
NPI:1134280407
Name:ANDERSON, ROBERT K
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RIVER OAKS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9534
Mailing Address - Country:US
Mailing Address - Phone:601-992-1222
Mailing Address - Fax:601-992-7222
Practice Address - Street 1:1040 RIVER OAKS DR STE 201
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9534
Practice Address - Country:US
Practice Address - Phone:601-992-1222
Practice Address - Fax:601-992-7222
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00785545OtherRAILROAD MEDICARE
MS02205931Medicaid
MS02205931Medicaid