Provider Demographics
NPI:1750462859
Name:ANDERSON, DALE R (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:R
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 1:101 E MINNESOTA ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7756
Mailing Address - Country:US
Mailing Address - Phone:605-341-1122
Mailing Address - Fax:605-341-2161
Practice Address - Street 1:101 E MINNESOTA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7756
Practice Address - Country:US
Practice Address - Phone:605-341-1122
Practice Address - Fax:605-341-2161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD1668207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0009785OtherBLUE CROSS BLUE SHIELD
SD6400420Medicaid
SD0936340001Medicare NSC
SDS9785Medicare ID - Type Unspecified
SDC35966Medicare UPIN