Provider Demographics
NPI:1427713239
Name:ANDERSON MEDICAL GROUP OF TEXAS PLLC
Entity type:Organization
Organization Name:ANDERSON MEDICAL GROUP OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:469-981-2648
Mailing Address - Street 1:1411 N BECKLEY AVE STE 352
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1270
Mailing Address - Country:US
Mailing Address - Phone:469-981-2648
Mailing Address - Fax:888-570-2264
Practice Address - Street 1:1411 N BECKLEY AVE STE 352
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1270
Practice Address - Country:US
Practice Address - Phone:469-981-2648
Practice Address - Fax:888-570-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty