Provider Demographics
NPI:1982674768
Name:ANDERSON, WILLIAM ALPHAUNCE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALPHAUNCE
Last Name:ANDERSON
Suffix:III
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 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:916 N 10TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5557
Practice Address - Country:US
Practice Address - Phone:425-391-5800
Practice Address - Fax:425-391-5801
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60448436208100000X
NJ25MA08150400208100000X
PAMD427455208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00472238Medicare PIN
I68176Medicare UPIN
PA107051GC6Medicare PIN
PA107051MWAMedicare PIN