Provider Demographics
NPI:1619972437
Name:ANDERSON, ROBERT SVEN (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SVEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15901 E BRIARWOOD CIR UNIT 300
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1786
Mailing Address - Country:US
Mailing Address - Phone:303-632-3668
Mailing Address - Fax:303-632-3669
Practice Address - Street 1:15901 E BRIARWOOD CIR UNIT 300
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1786
Practice Address - Country:US
Practice Address - Phone:303-632-3668
Practice Address - Fax:303-632-3669
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39105334Medicaid
COU09073Medicare UPIN
0364050001Medicare NSC
COCA1923Medicare PIN