Individual
KENNETH E ANDERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 E PEYTON ST, SHERMAN, TX 75090-0200
(903) 893-6000
(903) 868-1802
Mailing address
PO BOX 837, HOWE, TX 75459-0837
(903) 893-6000
(903) 868-1802
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L6764
TX
208VP0000X
Pain Medicine Physician
Primary
L6764
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0044ST
BCBS
—
05
—
161185701
—
TX
05
—
200019230A
—
OK
01
—
8B1207
BCBS PROV #
TX
Enumeration date
02/22/2006
Last updated
10/30/2019
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