Provider Demographics
NPI:1780909556
Name:ANDERSON, DAVID ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
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 1:621 E HAGUE RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2706
Mailing Address - Country:US
Mailing Address - Phone:240-620-3627
Mailing Address - Fax:
Practice Address - Street 1:1701 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2077
Practice Address - Country:US
Practice Address - Phone:360-426-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60367274207R00000X
DCMD044384207R00000X
VA0101261586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101261586OtherSTATE MEDICAL LICENSE
WAMD60367274OtherSTATE MEDICAL LICENSE
GA079257OtherSTATE MEDICAL LICENSE
NE26535OtherSTATE MEDICAL LICENSE
KY51670OtherSTATE MEDICAL LICENSE
SC51700OtherSTATE MEDICAL LICENSE
MI4301113582OtherSTATE MEDICAL LICENSE