1457452922 NPI number — CARROL L ANDERSON JR. M.D.

Table of content: CARROL L ANDERSON JR. M.D. (NPI 1457452922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457452922 NPI number — CARROL L ANDERSON JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CARROL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457452922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3302 BOCA CHICA BLVD STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78521-4271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-982-1001
Provider Business Mailing Address Fax Number:
956-982-1938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 BOCA CHICA BLVD STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78521-4271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-982-1001
Provider Business Practice Location Address Fax Number:
956-982-1938
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F6390 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: F6390 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172803202 . This is a "MEDICAID TEXAS HEALTH STEPS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140145728 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172803201 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00345Y . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com