Provider Demographics
NPI:1639215932
Name:ANDES, WILLARD ABE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:ABE
Last Name:ANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:403 S AMERICA ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3531
Mailing Address - Country:US
Mailing Address - Phone:919-610-9606
Mailing Address - Fax:958-276-4402
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-414-7878
Practice Address - Fax:360-414-7876
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61081628207RX0202X, 207R00000X
VAMD61081628207RH0000X
NC35830207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18582OtherMEDICAL LICENSE