Provider Demographics
NPI:1538239645
Name:ANDERSON, ERIC WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1630 HOSPITAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4772
Mailing Address - Country:US
Mailing Address - Phone:505-982-3534
Mailing Address - Fax:505-982-8458
Practice Address - Street 1:1630 HOSPITAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4772
Practice Address - Country:US
Practice Address - Phone:505-982-3534
Practice Address - Fax:505-982-8458
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2001-131208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09755276Medicaid
NM09755276Medicaid