1619120201 NPI number — REXFORD K.ANDERSON,JR,M.D.,P.A.

Table of content: (NPI 1619120201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619120201 NPI number — REXFORD K.ANDERSON,JR,M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REXFORD K.ANDERSON,JR,M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1619120201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 CYPRESS ST
Provider Second Line Business Mailing Address:
SUITE 609
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79601-5139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-672-5611
Provider Business Mailing Address Fax Number:
325-672-9241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 CYPRESS ST
Provider Second Line Business Practice Location Address:
SUITE 609
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79601-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-672-5611
Provider Business Practice Location Address Fax Number:
325-672-9241
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
REXFORD
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
325-672-5611

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  D4912 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com