Individual
DR. KYLE PRESTON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3615 19TH ST, LUBBOCK, TX 79410-1203
(806) 725-2233
(806) 725-0053
Mailing address
3420 22ND PL, LUBBOCK, TX 79410-1314
(806) 725-5844
(806) 723-6532
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
204058
LA
207P00000X
Emergency Medicine Physician
Primary
N3449
TX
390200000X
Student in an Organized Health Care Education/Training Program
204058
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8DV404
BCBS
TX
01
—
920057100
FIRSTCARE
TX
05
—
985396566
—
NM
Enumeration date
05/15/2007
Last updated
09/24/2013
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