Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 00G89620 | CA |
NPI | 1366490724 |
---|---|
Provider Name | William Dean Anderson JR. |
First Address | Turlock, CA 95382 |
Second Address | Turlock, CA 95382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58420 | (02) |