Provider Demographics
NPI:1790851509
Name:ANDERSON, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 JACKSON STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016
Mailing Address - Country:US
Mailing Address - Phone:765-646-8557
Mailing Address - Fax:765-646-8562
Practice Address - Street 1:2101 JACKSON STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-646-8557
Practice Address - Fax:765-646-8562
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01041764A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000079672OtherANTHEM BLUE CROSS
IN200026650BMedicaid
110111180OtherMEDICARE RAILROAD
IN200026650BMedicaid
110111180OtherMEDICARE RAILROAD