MEDICARE: DR. EDWARD RATCLIFFE ANDERSON III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	24197	AL
2	207X00000X	Orthopaedic Surgery Physician	N7603	TX
3	207XS0117X	Orthopaedic Surgery of the Spine Physician	N7603	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	259358YUWR	OTHER	TX	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013987536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD RATCLIFFE ANDERSON III MD

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD N
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191-6600
Country	:	US
Telephone Number	:	702-653-3040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 W OAKEY BLVD STE 2B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1535
Country	:	US
Telephone Number	:	702-579-3297
Fax Number	:	702-796-2302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	06/08/2021

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Directions to “ DR. EDWARD RATCLIFFE ANDERSON III MD” Practice Location

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