Healthcare Provider Details

I. General information

NPI: 1649236605
Provider Name (Legal Business Name): JUDITH DEANE ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N
ALLEN TX
75013-6103
US

IV. Provider business mailing address

1121 E SPRING CREEK PKWY STE. 110, #319
PLANO TX
75074
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-1000
  • Fax:
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDR.0076209
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: