Renner S Anderson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

24434 Issued in MN

Practice address

15111 Twelve Oaks Center Dr
Minnetonka, MN 55305-5201

Phone

(952) 993-4500

NPI assigned

Dec 26, 2005

Last updated

Oct 20, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1902883556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15111 TWELVE OAKS CENTER DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055201",
            "telephone_number": "952-993-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "RENNER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-26",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "24434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "699503900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Derek Steven Anderson, D.C.
• Erin Anderson, D.C.
• Janice C Anderson, CRNA
• Kathryn J Anderson, LICENSED PSYCHOLOGIS
• Owen Anderson, M.D.
• Robert Anderson, D.O.
• Romala Jayalakshmi Anderson, MA, LMFT
• Zeldie Mae Anderson
• Jared Andersson, MA
• Joshua Michael Andreae

• Pediatrics Physician in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.