Provider Demographics
NPI:1417064411
Name:ANDERSON, ROBERT FREDRICK (DPM,MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FREDRICK
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ACME RD
Mailing Address - Street 2:SUITE #206
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1546
Mailing Address - Country:US
Mailing Address - Phone:207-262-9562
Mailing Address - Fax:207-262-9564
Practice Address - Street 1:12 ACME RD
Practice Address - Street 2:SUITE #206
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1546
Practice Address - Country:US
Practice Address - Phone:207-262-9562
Practice Address - Fax:207-262-9564
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012968207Q00000X
MEPOD1028213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3015281OtherAETNA
ME010474554OtherMEDNET
ME433002600Medicaid
MEE89937OtherHARVARD PILGRIM
ME039571OtherANTHEM BC BS
ME039571OtherANTHEM BC BS
MEE89937OtherHARVARD PILGRIM