Dr. John Roger Anderson, D.O.
Radiology, Diagnostic Radiology in Coeur D Alene, ID. Individual provider (NPI-1).
NPI number1366490773
StatusActive
Last updated in NPPESAug 4, 2023
Details
- NPI
- 1366490773
- Entity type
- Individual (NPI-1)
- Name
- Dr. John Roger Anderson
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 5, 2006
- Certification date
- Aug 4, 2023
- Last updated
- Aug 4, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | O-0349 | ID | Yes |
| 2085R0202X | Radiology, Diagnostic Radiology | 0102204169 | VA |
Practice location
8611 W Eagle Ridge RdCoeur D Alene, ID 83814-9565
Phone 208-664-4455 · Fax 208-664-4159
Mailing address
8611 W Eagle Ridge RdCoeur D Alene, ID 83814-9565
Phone 208-664-4455 · Fax 208-664-4159
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