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1679559439

NPI Code Detail

MEDICARE: WADE E ANDERSON MD

MEDICARE: WADE E ANDERSON MD

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	15034	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P001900008	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	11179859	OTHER	NV	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679559439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE E ANDERSON MD

Provider Business Mailing Address
First Line	:	780 KUENZLI ST
Second Line	:	STE 202
City	:	RENO
State	:	NV
Zip	:	89502-0845
Country	:	US
Telephone Number	:	775-982-5068
Fax Number	:	775-982-5496

Provider Business Practice Location Address
First Line	:	1260 NEVADA PACIFIC BLVD
Second Line	:
City	:	FERNLEY
State	:	NV
Zip	:	89408-9871
Country	:	US
Telephone Number	:	775-575-7171
Fax Number	:	775-575-7227

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/21/2022

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Directions to “ WADE E ANDERSON MD” Practice Location

Language	Start Address	Practice Location

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