Individual
WADE E ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1260 NEVADA PACIFIC BLVD, FERNLEY, NV 89408-9871
(775) 575-7171
(775) 575-7227
Mailing address
780 KUENZLI ST, STE 202, RENO, NV 89502-0845
(775) 982-5068
(775) 982-5496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15034
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11179859
CAQH
NV
05
—
1571844
—
IA
05
—
1679559439
—
IA
05
—
1679559439
—
NV
05
—
2571844
—
IA
01
—
P001900008
RR MEDICARE
IA
Enumeration date
12/22/2005
Last updated
07/21/2022
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