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General NPI Number Information
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NPI Number | 1710056221
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Entity Type | Individual
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Provider Name | WILLIAM GOIN ANDERSON DO
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 2061 SMOKETREE AVENUE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403
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Country | US
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Telephone | 928-453-3332
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Fax | 928-453-1590
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Provider Business Mailing Address
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Address Line | 2061 SMOKETREE AVENUE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403
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Country | US
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Telephone | 928-453-3332
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Fax | 928-453-1590
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 3015
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License Number State | AZ
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