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General NPI Number Information
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NPI Number | 1457452922
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Entity Type | Individual
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Provider Name | CARROL L ANDERSON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 3302 BOCA CHICA BLVD STE 109
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4271
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Country | US
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Telephone | 956-982-1001
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Fax | 956-982-1938
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Provider Business Mailing Address
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Address Line | 3302 BOCA CHICA BLVD STE 109
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4271
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Country | US
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Telephone | 956-982-1001
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Fax | 956-982-1938
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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 | F6390
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F6390
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License Number State | TX
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