Provider Demographics
NPI:1366490724
Name:ANDERSON, WILLIAM DEAN JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3443
Mailing Address - Country:US
Mailing Address - Phone:209-417-1757
Mailing Address - Fax:209-417-1756
Practice Address - Street 1:1117 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3443
Practice Address - Country:US
Practice Address - Phone:209-417-1757
Practice Address - Fax:209-417-1756
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83962207YX0905X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58420Medicare UPIN
00G839620Medicare ID - Type Unspecified