Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 4811 | MT |
NPI | 1083698740 |
---|---|
Provider Name | Dr. William Carl Anderson |
First Address | Forsyth, MT 59327-0410 |
Second Address | Forsyth, MT 59327-0410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000017060 | BCBS OF MT (01) | MT |
0053329 | (05) | MT |
080179702 | RAILROAD MEDICARE (01) | MT |
D32668 | (02) | MT |