Individual
CARROL L ANDERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3302 BOCA CHICA BLVD STE 109, BROWNSVILLE, TX 78521-4271
(956) 982-1001
(956) 982-1938
Mailing address
3302 BOCA CHICA BLVD STE 109, BROWNSVILLE, TX 78521-4271
(956) 982-1001
(956) 982-1938
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F6390
TX
208D00000X
General Practice Physician
F6390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00345Y
MEDICARE GROUP NUMBER
TX
05
—
140145728
—
TX
01
—
172803201
MEDICAID GROUP NUMBER
TX
01
—
172803202
MEDICAID TEXAS HEALTH STEPS NUMBER
TX
Enumeration date
09/26/2006
Last updated
01/03/2017
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