Healthcare Provider Details

I. General information

NPI: 1396967659
Provider Name (Legal Business Name): C.L. ANDERSON, JR., M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 BOCA CHICA BLVD
BROWNSVILLE TX
78521-5193
US

IV. Provider business mailing address

3302 BOCA CHICA BLVD
BROWNSVILLE TX
78521-5193
US

V. Phone/Fax

Practice location:
  • Phone: 956-982-1001
  • Fax: 956-982-1938
Mailing address:
  • Phone: 956-982-1001
  • Fax: 956-982-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF6390
License Number StateTX

VIII. Authorized Official

Name: XAVIER ANDERSON
Title or Position: CEO
Credential:
Phone: 956-982-1001