Individual
ANTHONY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1327 TROUP HWY, SUITE 600, TYLER, TX 75701-4443
(903) 510-8840
(903) 510-1121
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02057
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508901596
—
TX
01
—
75-2616977-028
TRICARE
TX
01
—
P01572426
RAIL ROAD MEDICARE
TX
01
—
PA02057
TEXAS STATE LICENSE
TX
Enumeration date
02/20/2007
Last updated
02/20/2017
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