MEDICARE: WALTER C. ANDERSON III 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	207N00000X	Dermatology Physician	F1341	TX

General Provider Information

NPI Number	:	1982607230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER C. ANDERSON III MD

Provider Business Mailing Address
First Line	:	901A LOOP 337
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-3556
Country	:	US
Telephone Number	:	830-625-1786
Fax Number	:

Provider Business Practice Location Address
First Line	:	901A LOOP 337
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-3556
Country	:	US
Telephone Number	:	830-625-1786
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/15/2012

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