MEDICARE: WILLIAM ROBERT ANDERSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2597	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235130709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ROBERT ANDERSON DO

Provider Business Mailing Address
First Line	:	PO BOX 479
Second Line	:
City	:	GORE
State	:	OK
Zip	:	74435
Country	:	US
Telephone Number	:	918-489-5757
Fax Number	:	918-489-5411

Provider Business Practice Location Address
First Line	:	700 N MAIN
Second Line	:
City	:	GORE
State	:	OK
Zip	:	74435
Country	:	US
Telephone Number	:	918-489-5757
Fax Number	:	918-489-5411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/27/2011

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Directions to “ WILLIAM ROBERT ANDERSON DO” Practice Location

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