Healthcare Provider Details

I. General information

NPI: 1083698740
Provider Name (Legal Business Name): WILLIAM CARL ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N. 17TH AVENUE
FORSYTH MT
59327-0410
US

IV. Provider business mailing address

PO BOX 410
FORSYTH MT
59327-0410
US

V. Phone/Fax

Practice location:
  • Phone: 406-346-2916
  • Fax: 406-346-7478
Mailing address:
  • Phone: 406-346-2916
  • Fax: 406-346-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number4811
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: