Healthcare Provider Details

I. General information

NPI: 1285619668
Provider Name (Legal Business Name): KARIN S ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 MATLOCK RD
ARLINGTON TX
76015-2908
US

IV. Provider business mailing address

PO BOX 201606
DALLAS TX
75320-1606
US

V. Phone/Fax

Practice location:
  • Phone: 972-758-3523
  • Fax:
Mailing address:
  • Phone: 972-758-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL3909
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: