Provider Demographics
NPI:1831165174
Name:ANDERSON, WILLIAM D (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
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:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-263-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14637207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245606Medicaid
AZXPY162860OtherMEDI-CAL MEDICAID
AZAX4478OtherHEALTH NET AZ-PATH ASSOC
AZAZ0182900OtherBCBSAZ
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZAZ0828780OtherBCBSAZ
AZAZ0828780OtherBCBSAZ
AZXPY162860OtherMEDI-CAL MEDICAID
AZ1Z7112OtherHEALTH NET AZ-SUN CITY PA
AZAZ0182900OtherBCBSAZ
AZ245606Medicaid
AZ220024112Medicare PIN