Provider Demographics
NPI:1558362657
Name:ANDERSON, BRAD DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:DOUGLAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:90 HEALTH PARK DR
Practice Address - Street 2:SUITE 260
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9757
Practice Address - Country:US
Practice Address - Phone:303-673-9090
Practice Address - Fax:303-673-9195
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO37641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50305255Medicaid
COC359548Medicare PIN
CO50305255Medicaid