Provider Demographics
NPI:1215145776
Name:ANDERSON, ORSON ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ORSON
Middle Name:ANTONIO
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:
Practice Address - Street 1:1104 N AVENUE S
Practice Address - Street 2:
Practice Address - City:POST
Practice Address - State:TX
Practice Address - Zip Code:79356-2115
Practice Address - Country:US
Practice Address - Phone:806-495-2853
Practice Address - Fax:806-795-3576
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41825207Q00000X
TXJ2480207Q00000X
KS0419281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine