Provider Demographics
NPI:1306818828
Name:ANDERSON, HAMPTON W III (DO)
Entity Type:Individual
Prefix:DR
First Name:HAMPTON
Middle Name:W
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:306 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-3142
Mailing Address - Country:US
Mailing Address - Phone:580-584-3835
Mailing Address - Fax:
Practice Address - Street 1:902 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7337
Practice Address - Country:US
Practice Address - Phone:580-286-2600
Practice Address - Fax:580-286-1189
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-24017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8EZ13TMedicaid
OK8EZ13TMedicaid
OK8EZ13TMedicaid