Individual
DR. TERESA LOREE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1280 S MAIN ST, GRAPEVINE, TX 76051-7524
(817) 421-3376
(817) 416-4269
Mailing address
1280 S MAIN ST, GRAPEVINE, TX 76051-7524
(817) 421-3376
(817) 416-4269
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K0410
STATE LICENSE NUMBER
TX
Enumeration date
12/01/2006
Last updated
07/09/2007
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