Healthcare Provider Details

I. General information

NPI: 1326044355
Provider Name (Legal Business Name): ERNEST RUDOLPH ANDERS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 E LAUREL LN
SCOTTSDALE AZ
85260-5959
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-769-9691
  • Fax:
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: