Healthcare Provider Details

I. General information

NPI: 1366490724
Provider Name (Legal Business Name): WILLIAM DEAN ANDERSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E MAIN ST STE A
TURLOCK CA
95380-3443
US

IV. Provider business mailing address

1117 E MAIN ST STE A
TURLOCK CA
95380-3443
US

V. Phone/Fax

Practice location:
  • Phone: 209-417-1757
  • Fax: 209-417-1756
Mailing address:
  • Phone: 209-417-1757
  • Fax: 209-417-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG83962
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG83962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: