MEDICARE: ROBERT G ANDERSON 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	2086S0122X	Plastic and Reconstructive Surgery Physician	E4176	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240008036	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1326064270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G ANDERSON MD

Provider Business Mailing Address
First Line	:	800 12TH AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2519
Country	:	US
Telephone Number	:	817-810-0770
Fax Number	:	817-820-0242

Provider Business Practice Location Address
First Line	:	800 12TH AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2519
Country	:	US
Telephone Number	:	817-810-0770
Fax Number	:	817-820-0242

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/13/2021

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Directions to “ ROBERT G ANDERSON MD” Practice Location

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