Provider Demographics
NPI:1366490724
Name:ANDERSON, WILLIAM DEAN JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 COLORADO AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:209-216-3300
Mailing Address - Fax:209-216-3301
Practice Address - Street 1:1801 COLORADO AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-216-3300
Practice Address - Fax:209-216-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G89620207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58420Medicare UPIN
00G839620Medicare ID - Type Unspecified