Organization
LAWRENCE L ANDERSON MD PA
Active
Organization
LAWRENCE L ANDERSON MD PA
Active
Other names
Dermatology Associates Of Tyler
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA LYNNE STEIN RN (PRACTICE ADMINISTRATOR)
(903) 534-6200
Entity
Organization
Contact information
Practice address
1367 DOMINION PLZ, TYLER, TX 75703-1013
(903) 534-6200
Mailing address
1367 DOMINION PLZ, TYLER, TX 75703-1013
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U08Z
BLUE CROSS AND BLUE SHIELD
TX
05
—
085541301
—
TX
01
—
CN9571
RAILROAD MEDICARE PTAN
TX
Enumeration date
07/11/2006
Last updated
05/22/2008
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