Provider Demographics
NPI:1386689628
Name:ANDERSON, DENNIS ROLLAND (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROLLAND
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 5TH AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3621
Mailing Address - Country:US
Mailing Address - Phone:206-624-6050
Mailing Address - Fax:206-838-3085
Practice Address - Street 1:1601 5TH AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3621
Practice Address - Country:US
Practice Address - Phone:206-624-6050
Practice Address - Fax:206-838-3085
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1159003Medicaid
WAE28090Medicare UPIN
WA1159003Medicaid