MEDICARE: WILLIAM GOIN 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	207N00000X	Dermatology Physician	3015	AZ

General Provider Information

NPI Number	:	1710056221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM GOIN ANDERSON DO

Provider Business Mailing Address
First Line	:	2061 SMOKETREE AVENUE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403
Country	:	US
Telephone Number	:	928-453-3332
Fax Number	:	928-453-1590

Provider Business Practice Location Address
First Line	:	2061 SMOKETREE AVENUE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403
Country	:	US
Telephone Number	:	928-453-3332
Fax Number	:	928-453-1590

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/07/2008

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