Healthcare Provider Details

I. General information

NPI: 1164582540
Provider Name (Legal Business Name): ANDERSON AUDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 S RAINBOW BLVD STE 202
LAS VEGAS NV
89146-6235
US

IV. Provider business mailing address

3120 S RAINBOW BLVD #202
LAS VEGAS NV
89146-6235
US

V. Phone/Fax

Practice location:
  • Phone: 702-233-4327
  • Fax: 702-233-8837
Mailing address:
  • Phone: 702-233-4327
  • Fax: 702-233-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-010
License Number StateNV

VIII. Authorized Official

Name: DR. DAVID E ANDERSON
Title or Position: OWNER
Credential: AU.D.,CCC-A
Phone: 702-233-4327