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General NPI Number Information
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NPI Number | 1215145776
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Entity Type | Individual
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Provider Name | ORSON ANTONIO ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 1104 N AVENUE S
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City | POST
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State | TX
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Zip | 79356-2115
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Country | US
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Telephone | 806-495-2853
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Fax | 806-795-3576
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Provider Business Mailing Address
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Address Line | 5219 CITY BANK PKWY SUITE 15
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City | LUBBOCK
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State | TX
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Zip | 79407-3544
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Country | US
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Telephone | 806-761-0333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A41825
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J2480
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0419281
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License Number State | KS
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