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Individual

MARK R ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 593-8441
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
J0423
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005
TRICARE
TX
01
0061EK
BCBS
TX
01
015
TRICARE
TX
05
130578103
TX
05
130578107
TX
05
130578108
TX
05
130578109
TX
05
130578110
TX
01
75-0818167-048
TRICARE
TX
01
75-2616977-001
TRICARE
TX
01
75-2616977-002
TRICARE
TX
01
75-2616977-028
TRICARE
TX
01
750818167-044
TRICARE
TX
01
750818167022
TRICARE
TX
01
8DQ330
BCBS
TX
01
8EX117
BCBS
TX
01
8L1047
BCBS
TX
01
990014514
RAIL ROAD
TX
01
P01464103
RAIL ROAD MEDICARE
TX
Enumeration date
06/06/2006
Last updated
07/10/2015
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