Provider Demographics
NPI:1063156347
Name:ALBERT ROBERT ANDERSON III A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ALBERT ROBERT ANDERSON III A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:760-760-6983
Mailing Address - Street 1:81719 DR CARREON BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5518
Mailing Address - Country:US
Mailing Address - Phone:760-462-6880
Mailing Address - Fax:442-300-2206
Practice Address - Street 1:1000 E LATHAM AVE STE G
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4409
Practice Address - Country:US
Practice Address - Phone:951-391-0580
Practice Address - Fax:951-391-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty