Provider Demographics
NPI:1912328014
Name:ANDERSON, DAVID (MD, PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W 76TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3004
Mailing Address - Country:US
Mailing Address - Phone:952-929-1131
Mailing Address - Fax:952-929-8873
Practice Address - Street 1:3601 W 76TH ST STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3004
Practice Address - Country:US
Practice Address - Phone:952-929-1131
Practice Address - Fax:952-929-8873
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL15730207R00000X
MN73503207WX0107X
ND52871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist