MEDICARE: DR. MARSHALL WILLIAM ANDERSON 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	2083P0901X	Public Health & General Preventive Medicine Physician	MD00037814	WA
2	2083X0100X	Occupational Medicine Physician	MD00037814	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	263663	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1417942038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL WILLIAM ANDERSON MD

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:	C/O CREDENTIALING
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2500
Fax Number	:	360-428-6485

Provider Business Practice Location Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-848-4150
Fax Number	:	360-848-4169

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/22/2021

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Directions to “ DR. MARSHALL WILLIAM ANDERSON MD” Practice Location

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