NPI 1366490773 · live from the CMS NPI Registry
John Roger Anderson, D.O.
Radiology, Diagnostic Radiology in Coeur D Alene, ID. National Provider Identifier 1366490773, active.
NPI record
| NPI | 1366490773 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 8611 W Eagle Ridge Rd, Coeur D Alene, ID 83814 |
| Practice phone | 208-664-4455 |
| Enumerated | May 5, 2006 |
| Last updated | August 4, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | 0102204169 (VA) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | O-0349 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.