Healthcare Provider Details

I. General information

NPI: 1942562434
Provider Name (Legal Business Name): DORIAN MARQUIS ANDERSON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR MCHE-QD
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

36065 SANTE FE AVENUE
FORT HOOD TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9900
  • Fax:
Mailing address:
  • Phone: 254-288-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102204108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: