Provider Demographics
NPI:1013987536
Name:ANDERSON, EDWARD RATCLIFFE III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RATCLIFFE
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 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-3040
Mailing Address - Fax:
Practice Address - Street 1:4750 W OAKEY BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1535
Practice Address - Country:US
Practice Address - Phone:702-579-3297
Practice Address - Fax:702-796-2302
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24197207X00000X
TXN7603207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX259358YUWROtherMEDICARE PTAN
TX323319903Medicaid
TX3233199-05Medicaid
TX259358YXAJMedicare PIN