Basic Information
| Provider Information | |||||||||
| NPI: | 1932104858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633448600 | ||||||||
| FaxNumber: | 5633442967 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE 210 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633448600 | ||||||||
| FaxNumber: | 5633442967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 21074 | IA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 29872 | 01 | IA | WELLMARK BC/BS | OTHER | 20101 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 034783 | 01 | HEALTH ALLIANCE | OTHER | 1200578 | 05 | IA | MEDICAID | IA0105 | 01 | JOHN DEERE HEALTH PLAN | OTHER |