MEDICARE: DR. C NEVIN ANDERSON JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E0785	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G6950	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073710828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C NEVIN ANDERSON JR. MD

Provider Business Mailing Address
First Line	:	601 E SAN ANTONIO ST STE 203W
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-6051
Country	:	US
Telephone Number	:	361-573-6371
Fax Number	:	361-573-7961

Provider Business Practice Location Address
First Line	:	601 E SAN ANTONIO ST STE 203W
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-6051
Country	:	US
Telephone Number	:	361-573-6371
Fax Number	:	361-573-7961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	08/26/2020

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