Provider Demographics
NPI:1518955053
Name:ANDERSON, STEVEN RAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W 24TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8877
Mailing Address - Country:US
Mailing Address - Phone:928-726-9385
Mailing Address - Fax:928-726-9382
Practice Address - Street 1:2140 W 24TH ST
Practice Address - Street 2:STE B
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8877
Practice Address - Country:US
Practice Address - Phone:928-726-9385
Practice Address - Fax:928-726-9382
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1508961343OtherGROUP NPI
AZ1508961343OtherGROUP NPI
AZP00368024Medicare PIN