Provider Demographics
NPI:1720178080
Name:ANDERSON, WILLIAM WAY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAY
Last Name:ANDERSON
Suffix:
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 1:9330 BALADA ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2361
Mailing Address - Country:US
Mailing Address - Phone:305-661-2907
Mailing Address - Fax:305-661-6036
Practice Address - Street 1:9330 BALADA ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33156-2361
Practice Address - Country:US
Practice Address - Phone:305-661-2907
Practice Address - Fax:305-661-6036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9095207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65912Medicare UPIN