Individual
DR. JOSE LUIS DE ANDA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 ANTHONY DR, ANTHONY, NM 88021
(505) 882-2956
(505) 882-1863
Mailing address
PO BOX 4530, ANTHONY, TX 79821-0047
(505) 882-2956
(505) 882-1863
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2002-1081
NM
208000000X
Pediatrics Physician
L4904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1595985021
—
TX
05
—
17907543
—
NM
Enumeration date
07/12/2005
Last updated
07/08/2007
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