Individual
DR. WILLIAM WALLACE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 BARBARA LOOP SE STE A, RIO RANCHO, NM 87124-1088
(505) 892-9711
(505) 892-5206
Mailing address
1400 BARBARA LOOP SE STE A, RIO RANCHO, NM 87124-1088
(505) 892-9711
(505) 892-5206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
78-105
NM
225B00000X
Pulmonary Function Technologist
78105
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17418
—
NM
01
—
85-0455201
FEDID
NM
01
—
850455201
DEFAULT NUMBER
NM
Enumeration date
10/26/2006
Last updated
11/13/2025
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