Provider Demographics
NPI:1720098064
Name:ANDERSON, JADE GARRETT (MD)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:GARRETT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:1826 POINT WEST PKWY
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2167
Practice Address - Country:US
Practice Address - Phone:806-358-8654
Practice Address - Fax:806-356-8687
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42135207RX0202X
TXU8467207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN946423900Medicaid
MN3600554OtherSELECT CARE
MN3600554Other3600554
MN500T4ANOtherBLUE CROSS BLUE SHIELD
MNHP32508OtherHEALTH PARTNERS
MN143482OtherUCARE
MN963001032272OtherPREFERRED ONE
MN900000272Medicare ID - Type UnspecifiedMEDICAL ONCOLOGY
MN946423900Medicaid