Provider Demographics
NPI:1205005022
Name:ERNEST RUDOLPH ANDERS III M D P C
Entity Type:Organization
Organization Name:ERNEST RUDOLPH ANDERS III M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-769-9691
Mailing Address - Street 1:7600 N 15TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4336
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:7600 N 16TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4431
Practice Address - Country:US
Practice Address - Phone:602-443-2325
Practice Address - Fax:602-277-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24202207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty