Provider Demographics
NPI:1396788022
Name:MEHRLE, ANDERSON P (MD)
Entity type:Individual
Prefix:DR
First Name:ANDERSON
Middle Name:P
Last Name:MEHRLE
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 1:226 SE DEBELL AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2343
Mailing Address - Country:US
Mailing Address - Phone:918-332-3600
Mailing Address - Fax:918-332-3613
Practice Address - Street 1:3460 SE FRANK PHILLIPS
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2495
Practice Address - Country:US
Practice Address - Phone:918-332-3600
Practice Address - Fax:918-332-3613
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16512207RC0000X
OK26605207RC0000X
KS04-33592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200211900AMedicaid
MS512I060002OtherMEDICARE PTAN 2008
MS04029571Medicaid
KS200606720AMedicaid
124332Medicare UPIN
MSI24332Medicare UPIN
MS04029571Medicaid
OK200211900AMedicaid
MS060000862Medicare PIN