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Individual
KENNETH E ANDERSON JR.
Active
Individual
KENNETH E ANDERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L6764
TX
208VP0000X
Pain Medicine Physician
Primary
L6764
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0044ST
BCBS
—
05
—
161185701
—
TX
05
—
200019230A
—
OK
01
—
8B1207
BCBS PROV #
TX
Enumeration date
02/22/2006
Last updated
10/30/2019
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