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Contact Information

BLAKE ANDERSON, MD
1344 RED OAK PLANTATION DR
BALLWIN, MO63021-7346
 Phone: 314-591-3417
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for BLAKE ANDERSON · (Male)

NPI # 1093798134
Status Active
Credentials MD
Entity Individual
Enumeration date 11/22/2005
Last updated 04/08/2014 - About 12 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2009013290
  • MN Medicaid 150459
  • MN Medicaid 16690100
  • MO Medicaid 1093798134
  • MN Other 1019018 ARAZ
  • MN Other 7291 AVERA
  • MN Other 67Q18AN BLUE CROSS/BLUE PLUS
  • MN Other A035 CHAMPUS
  • MN Other HP30702 HEALTHPARTNERS
  • MN Other 01-13048 MEDICA
  • MN Other MH9041023739 PREFERRED ONE
  • MN Other 21955 SIOUX VALLEY HEALTH PLANS
Hospital affiliation(s)
  • GOLDEN VALLEY MEMORIAL HOSPITAL - (Acute Care)
    1600 N 2ND ST
    CLINTON, MO 64735
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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