Individual provider · Type 1 NPI

Blake Anderson, DO

Student in an Organized Health Care Education/Training Program · St. Louis, MO

NPI number 1063271641 Active

Practice location

1402 S Grand Blvd # M260
St. Louis, MO 63104-1004

Call (618) 210-5609 Map

Mailing address

3100 Channing Way
Idaho Falls, ID 83404-7533

Other practice locations

  • 3100 Channing Way, Idaho Falls, ID 83404-7533 · (208) 227-2850

Specialties and licenses

TaxonomyCodeLicense
Internal Medicine Physician 207R00000XMRO-2400 (ID)
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1063271641

Blake Anderson, DO's National Provider Identifier is 1063271641, issued on Mar 18, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in St. Louis, MO. The record was last updated on Mar 26, 2025.