Brock Anderson, MD
Individual provider Active NPI Surgery Physician · Casper, WY
NPI 1962481655 · NPPES record last updated Jul 20, 2011
Key facts
- NPI
- 1962481655
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 8753A (WY)
- Practice address
- 419 S Washington St Ste 102
Casper, WY 82601-2951 - Phone
- (307) 577-4220
- Fax
- (307) 235-0931
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A93051 | CA | |
| Trauma Surgery Physician | 2086S0127X | A93051 | CA | |
| Surgery Physician | 208600000X | 8753A | WY | Yes |
| Trauma Surgery Physician | 2086S0127X | 8753A | WY | |
| Surgical Critical Care Physician | 2086S0102X | 8753A | WY | |
| Vascular Surgery Physician | 2086S0129X | 8753A | WY |
Addresses
Primary practice location
419 S Washington St Ste 102
Casper, WY 82601-2951
Mailing address
419 S Washington St Ste 102
Casper, WY 82601-2951
Phone (307) 577-4220
Other providers in Casper, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.