Individual
CODY N. ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12201 RENFERT WAY, SUITE 115, AUSTIN, TX 78758
(512) 551-0375
(512) 551-0634
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
(512) 551-0634
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
N0606
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196190601
—
TX
05
—
196190607
—
TX
01
—
327352YSWM
MEDICARE
TX
01
—
8BE151
BCBS
TX
01
—
P02028499
MEDICARE RAIL ROAD
TX
Enumeration date
11/07/2007
Last updated
06/18/2018
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