Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. SHANE KEITH ANDERSON, D.O.
Active Sole ProprietorInternal Medicine · MALAD CITY, ID
Registration Details
- NPI Number
- 1841289659
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Oct 14, 2005 (20.517849199037 yrs)
- Last Updated
- May 24, 2011
- Licenses
-
2004001424 (MO)11818 (MT)
- Sole Proprietor
- Yes
Practice Information
- Address
-
220 BANNOCK STMALAD CITY, ID, 832521256Browse ID providers · Browse ZIP 83252
- Phone
- 2087662600
- Primary Specialty
-
Internal Medicine
207R00000X
- Additional Specialty
- Internal Medicine
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.