Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 24197 | AL |
N | 207X00000X | Orthopaedic Surgeon | N7603 | TX |
Y | 207XS0117X | Orthopaedic Spine Surgeon | N7603 | TX |
NPI | 1013987536 |
---|---|
Provider Name | Dr. Edward Ratcliffe Anderson III |
First Address | Nellis Afb, NV 89191-6600 |
Second Address | Las Vegas, NV 89102-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259358YUWR | MEDICARE PTAN (01) | TX |
323319903 | (05) | TX |
3233199-05 | (05) | TX |