# WILLOW VALLEY MEDICAL CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134111834
- **Authorized official:** DONOVAN J ANDERSON MD (PHYSICIAN)
- **Authorized official phone:** (760) 217-2464

## Contact information

- **Practice address:** 8700 HIGHWAY 95, MOHAVE VALLEY, AZ 86440-8519
- **Practice address phone:** (760) 217-2464
- **Practice address fax:** (928) 453-9207
- **Mailing address:** 8700 HIGHWAY 95, MOHAVE VALLEY, AZ 86440-8519
- **Mailing address phone:** (760) 217-2464
- **Mailing address fax:** (928) 453-9207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 13491 | AZ | Yes |

## Other

- **Enumeration date:** 08/18/2005
- **Last updated:** 02/08/2018

## 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 |