Provider Demographics
NPI:1427039759
Name:ANDERSON, WARNER J (MD)
Entity Type:Individual
Prefix:DR
First Name:WARNER
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2559
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-2559
Mailing Address - Country:US
Mailing Address - Phone:505-507-3173
Mailing Address - Fax:
Practice Address - Street 1:218 COUSINS ROAD
Practice Address - Street 2:
Practice Address - City:VANDERWAGEN
Practice Address - State:NM
Practice Address - Zip Code:87326
Practice Address - Country:US
Practice Address - Phone:505-507-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-6207PE0004X, 207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine