Individual
DR. CHARLES W ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL DOCTOR
Contact information
Practice address
123 CRUZ ALTA, TAOS, NM 87571-6279
(505) 758-8651
(505) 758-7811
Mailing address
123 CRUZ ALTA, TAOS, NM 87571-6279
(505) 758-8651
(505) 758-8711
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
64-23
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1305
—
NM
Enumeration date
05/01/2006
Last updated
08/31/2007
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