Provider Demographics
NPI:1700841277
Name:ANDERSON, ROBERT H (PA C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-5096
Mailing Address - Country:US
Mailing Address - Phone:406-622-5485
Mailing Address - Fax:
Practice Address - Street 1:1518 CHOUTEAU ST
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442-9003
Practice Address - Country:US
Practice Address - Phone:406-622-5485
Practice Address - Fax:406-622-5670
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-289363AM0700X
MT155263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04479Medicare UPIN