Healthcare Provider Details

I. General information

NPI: 1679559439
Provider Name (Legal Business Name): WADE E ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 NEVADA PACIFIC BLVD
FERNLEY NV
89408-9871
US

IV. Provider business mailing address

780 KUENZLI ST STE 202
RENO NV
89502-0845
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-7171
  • Fax: 775-575-7227
Mailing address:
  • Phone: 775-982-5068
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15034
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: