Provider Demographics
NPI:1720098064
Name:ANDERSON, JADE GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JADE
Middle Name:GARRETT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:480 OSBORNE RD NE
Practice Address - Street 2:SUITE 220
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2773
Practice Address - Country:US
Practice Address - Phone:763-786-1620
Practice Address - Fax:763-780-3099
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN42135207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP32508OtherHEALTH PARTNERS
MN946423900Medicaid
MN963001032272OtherPREFERRED ONE
MN3600554OtherSELECT CARE
MN3600554Other3600554
MN500T4ANOtherBLUE CROSS BLUE SHIELD
MN143482OtherUCARE
MN900000272Medicare ID - Type UnspecifiedMEDICAL ONCOLOGY
MN946423900Medicaid