Provider Demographics
NPI:1205831120
Name:ANDERSON, GARY E (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:210 W 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2251
Practice Address - Country:US
Practice Address - Phone:563-386-3436
Practice Address - Fax:563-386-3211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0104OtherJOHN DEERE HEALTH PLAN
4796890009OtherDMERC
034792OtherHEALTH ALLIANCE
IA1160432Medicaid
20100OtherIOWA HEALTH SOLUTIONS
IA40197OtherWELLMARK BC/BS
20100OtherIOWA HEALTH SOLUTIONS
IA40197OtherWELLMARK BC/BS