Provider Demographics
NPI:1013002435
Name:ANDERSON, ALBERT R III (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:R
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 1:81719 DR CARREON BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5518
Mailing Address - Country:US
Mailing Address - Phone:760-462-6880
Mailing Address - Fax:442-300-2206
Practice Address - Street 1:81719 DR CARREON BLVD STE F
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5518
Practice Address - Country:US
Practice Address - Phone:760-462-6880
Practice Address - Fax:442-300-2206
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560133Medicare ID - Type Unspecified
CAG12403Medicare UPIN