Paul Richard Anderson
Individual provider Active NPI Anesthesiology Physician · Duluth, MN
NPI 1487717047 · NPPES record last updated Jun 24, 2011
Key facts
- NPI
- 1487717047
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 25596 (MN)
- Practice address
- 400 E 3Rd St
Duluth, MN 55805-1951 - Phone
- (218) 786-4150
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Duluth Clinic, LTD | Current | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000
3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457
3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 25596 | MN | Yes |
Addresses
Primary practice location
400 E 3Rd St
Duluth, MN 55805-1951
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-4150
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 165500100 | Medicaid | MN |
Other providers in Duluth, MN
- Meredith Anderson
- Michael Kris Anderson
- Michelle Louise Anderson
- Molly Ann Anderson
- Neil J Anderson
- Robb Evan Anderson
- Robin Joy Anderson
- Ross Allen Anderson
- Ryan Taylor Anderson
- Sally L Anderson
All providers in Duluth, MN · Anesthesiology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.