Provider Demographics
NPI:1356320675
Name:ANDERSON, DANIEL P (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1575 LOOKOUT DR
Practice Address - Street 2:MANKATO CLINIC AT NORTH MANKATO
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003
Practice Address - Country:US
Practice Address - Phone:507-625-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP24183OtherHEALTH PARTNERS
MN121157OtherUCARE
MN597149OtherAMERICAS PPO
MNNA2951023810OtherPREFERRED ONE
41084933956001C075OtherCHAMPUS
MN41215ANOtherBCBS
080067570OtherRR MEDICARE
MN121303200Medicaid
MN0101164OtherMEDICA
MNNA2951023810OtherPREFERRED ONE
E29286Medicare UPIN