Basic Information
| Provider Information | |||||||||
| NPI: | 1992836100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LOWELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3721 N 2544 E | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833011003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087328025 | ||||||||
| FaxNumber: | 2087326156 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE WEST BURDICK EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587025020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10060 | ND | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | M-5620 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.