Provider Demographics
NPI:1396967659
Name:C.L. ANDERSON, JR., M.D., PLLC
Entity type:Organization
Organization Name:C.L. ANDERSON, JR., M.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-982-1001
Mailing Address - Street 1:3302 BOCA CHICA BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-5193
Mailing Address - Country:US
Mailing Address - Phone:956-982-1001
Mailing Address - Fax:956-982-1938
Practice Address - Street 1:3302 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-5193
Practice Address - Country:US
Practice Address - Phone:956-982-1001
Practice Address - Fax:956-982-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
TXF6390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172803201Medicaid
TX172803201Medicaid