Provider Demographics
NPI:1588617427
Name:ANDERSEN, ROBERT DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAN
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BUILDING E, SUITE 201
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-685-1605
Mailing Address - Fax:270-685-5535
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BUILDING E, SUITE 201
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-685-1605
Practice Address - Fax:270-685-5535
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY33223208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64039415Medicaid
KY64039415Medicaid
KY0676201Medicare UPIN