MEDICARE: MARCUS R. ANDERSON, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	P2575	TX

General Provider Information

NPI Number	:	1700220761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCUS R. ANDERSON, MD

Provider Business Mailing Address
First Line	:	198 NORMANDY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2064
Country	:	US
Telephone Number	:	713-451-6784
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 NORMANDY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2064
Country	:	US
Telephone Number	:	713-451-6784
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARCUS RAY ANDERSON
Credential	:	M.D.
Telephone Number	:	713-540-9200

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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