Active NPI
Roger Carl Andersen, MD
- Obstetrics & Gynecology Physician
- Lynnwood, WA
National Provider Identifier
1821319484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 00020615
- Practice address
- 13619 Mukilteo Speedway
Ste D-543
Lynnwood, WA 98087-1626 - Phone
- (425) 246-9824
- Fax
- (250) 722-7160
- NPI assigned
- Jun 17, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 00020615 | WA | Primary |
Addresses
Primary practice location
13619 Mukilteo Speedway
Ste D-543
Lynnwood, WA 98087-1626
Mailing address
13619 Mukilteo Speedway
Ste D-543
Lynnwood, WA 98087-1626
Phone (425) 246-9824
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00020615 | WA | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276732800000",
"number": "1821319484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13619 MUKILTEO SPEEDWAY",
"address_2": "STE D-543",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980871626",
"telephone_number": "425-246-9824",
"fax_number": "250-722-7160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13619 MUKILTEO SPEEDWAY",
"address_2": "STE D-543",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980871626",
"telephone_number": "425-246-9824",
"fax_number": "250-722-7160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "ROGER",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-17",
"last_updated": "2010-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "WA",
"license": "00020615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.