Provider Demographics
NPI:1467433979
Name:ANDERSON, TOM (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30976
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-0976
Mailing Address - Country:US
Mailing Address - Phone:406-238-6290
Mailing Address - Fax:406-238-6961
Practice Address - Street 1:1025 9TH ST
Practice Address - Street 2:#B
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3441
Practice Address - Country:US
Practice Address - Phone:307-587-5622
Practice Address - Fax:307-587-5657
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9660207RH0003X
WY6512A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115669100Medicaid
MT0045390Medicaid
MT810511516010OtherEBMS
WY308613OtherBLUE CROSS
MT000092981OtherBLUE CROSS
WY308613OtherBLUE CROSS
WY115669100Medicaid
MT0045390Medicaid
MT900003389Medicare ID - Type UnspecifiedMEDICARE RAILROAD
B81186Medicare UPIN