Healthcare Provider Details

I. General information

NPI: 1528182839
Provider Name (Legal Business Name): ANDREW E ANDERSON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N HIGHWAY 377 STE 110
PILOT POINT TX
76258-3765
US

IV. Provider business mailing address

PO BOX 1979 1340 N HWY 377 STE 110
PILOT POINT TX
76258-1979
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-0860
  • Fax: 940-686-5834
Mailing address:
  • Phone: 940-686-0860
  • Fax: 940-686-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: