Healthcare Provider Details

I. General information

NPI: 1962460220
Provider Name (Legal Business Name): MARY ESSEMENA ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ES ANDERSON-BEAVER

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 FANNIN ST STE 1800
HOUSTON TX
77054
US

IV. Provider business mailing address

10740 N GESSNER DR STE 310
HOUSTON TX
77064-1240
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-9363
  • Fax: 713-795-0488
Mailing address:
  • Phone: 281-897-0416
  • Fax: 281-890-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberK3554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: