Provider Demographics
NPI:1922097807
Name:ANDERSON, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
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 1:2115 NE WYATT CT STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7680
Mailing Address - Country:US
Mailing Address - Phone:541-647-5200
Mailing Address - Fax:541-389-5459
Practice Address - Street 1:2115 NE WYATT CT STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7680
Practice Address - Country:US
Practice Address - Phone:541-647-5200
Practice Address - Fax:541-389-5459
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA818712084P0800X
ORMD293742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry