=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083872865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANEAR ROCHELLE ANDERSON M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2008
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1903 DOCTORS HOSPITAL DR SUITE 36
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76426-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-683-3014
-----------------------------------------------------
Fax | 940-683-3017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2078
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76234-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-683-3014
-----------------------------------------------------
Fax | 940-683-3017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | N5532
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | N5532
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------