Active NPI
Gerald Frederick Anderson, PA
- Surgical Physician Assistant
- Duluth, MN
National Provider Identifier
1194042390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- Practice address
- 4060 Haines Rd
#104
Duluth, MN 55811-1746 - Phone
- (952) 250-6435
- NPI assigned
- Apr 27, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | Primary |
Addresses
Primary practice location
4060 Haines Rd
#104
Duluth, MN 55811-1746
Mailing address
4060 Haines Rd
#104
Duluth, MN 55811-1746
Phone (952) 250-6435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272326400000",
"number": "1194042390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4060 HAINES RD",
"address_2": "#104",
"city": "DULUTH",
"state": "MN",
"postal_code": "558111746",
"telephone_number": "952-250-6435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4060 HAINES RD",
"address_2": "#104",
"city": "DULUTH",
"state": "MN",
"postal_code": "558111746",
"telephone_number": "952-250-6435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "GERALD",
"middle_name": "FREDERICK",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-27",
"last_updated": "2010-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.