Provider Demographics
NPI:1861468118
Name:ANDERSON, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6671
Mailing Address - Fax:913-588-6671
Practice Address - Street 1:10720 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-588-6671
Practice Address - Fax:913-588-6671
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20418207L00000X
KS0420418208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100200370DMedicaid
KSP00106987OtherRR MEDICARE
MO209214808Medicaid
KSP00115674OtherRR MEDICARE
KS100200370EMedicaid
MO209214816Medicaid
KSP00106987Medicare PIN
KSP00115674Medicare PIN
KSP00106987OtherRR MEDICARE
KSP80A373Medicare PIN