Provider Demographics
NPI:1477541365
Name:ANDERSON, CRAIG S (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
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 1:2490 W 26TH AVE BLDG A
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5314
Mailing Address - Country:US
Mailing Address - Phone:303-831-9393
Mailing Address - Fax:303-468-9280
Practice Address - Street 1:2490 W 26TH AVE BLDG A
Practice Address - Street 2:SUITE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5314
Practice Address - Country:US
Practice Address - Phone:303-831-9393
Practice Address - Fax:303-468-9280
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19988206Medicaid
CO348308OtherMEDICARE GROUP PTAN
COC811604OtherMEDICARE GROUP NUMBER
CO348308OtherMEDICARE GROUP PTAN
CO19988206Medicaid
COCO300225Medicare PIN