Basic Information
| Provider Information | |||||||||
| NPI: | 1417995291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANDERSON | ||||||||
| OtherFirstName: | WILLIAM | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 861 SW 78TH AVE | ||||||||
| Address2: | SUITE 100B | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546930000 | ||||||||
| FaxNumber: | 9546930005 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 N WOOD ST | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | GILMER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756441751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038417100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | H3365 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.