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Individual
ANTHONY ANDERSON
Active
Individual
ANTHONY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508901596
—
TX
01
—
75-2616977-028
TRICARE
TX
01
—
P01572426
RAIL ROAD MEDICARE
TX
01
—
PA02057
TEXAS STATE LICENSE
TX
Enumeration date
02/20/2007
Last updated
02/20/2017
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