Provider Demographics
NPI:1376604231
Name:ANDERSON, RONALD WARREN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WARREN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N 97TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2398
Mailing Address - Country:US
Mailing Address - Phone:402-691-0416
Mailing Address - Fax:402-691-0416
Practice Address - Street 1:407 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1907
Practice Address - Country:US
Practice Address - Phone:402-426-2210
Practice Address - Fax:402-426-2235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE30200OtherBCBS
NE10025285200Medicaid
NE279415Medicare ID - Type Unspecified
NE30200OtherBCBS