Provider Demographics
NPI:1477645588
Name:DR ROBERT L ANDERSON INC
Entity Type:Organization
Organization Name:DR ROBERT L ANDERSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREMAINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:OATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-519-2900
Mailing Address - Street 1:33565 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2952
Mailing Address - Country:US
Mailing Address - Phone:440-519-2900
Mailing Address - Fax:
Practice Address - Street 1:33565 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2952
Practice Address - Country:US
Practice Address - Phone:440-519-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001275213E00000X
OH36-001994213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCL1675OtherRAILROAD MEDICARE
OH2040820Medicaid
OH2040820Medicaid