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Organization
WILLOW VALLEY MEDICAL CENTER PC
Active
Organization
WILLOW VALLEY MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONOVAN J ANDERSON MD (PHYSICIAN)
(760) 217-2464
Entity
Organization
Contact information
Practice address
8700 HIGHWAY 95, MOHAVE VALLEY, AZ 86440-8519
(760) 217-2464
(928) 453-9207
Mailing address
8700 HIGHWAY 95, MOHAVE VALLEY, AZ 86440-8519
(760) 217-2464
(928) 453-9207
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13491
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205288-002
—
AZ
05
—
205288-01
—
AZ
01
—
AZ0325100
AZ BCBS
AZ
01
—
DI935A
MEDICARE PTAN
CA
05
—
XPY055881
—
CA
Enumeration date
08/18/2005
Last updated
02/08/2018
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