MEDICARE: ANDERSON MEDICAL ASSOCIATES PA

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	207R00000X	Internal Medicine Physician	K2840	TX

General Provider Information

NPI Number	:	1578734786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON MEDICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1800 WINDMILL HILL LN
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2768
Country	:	US
Telephone Number	:	214-789-6568
Fax Number	:	972-780-2796

Provider Business Practice Location Address
First Line	:	1800 WINDMILL HILL LN
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2768
Country	:	US
Telephone Number	:	214-789-6568
Fax Number	:	972-780-2796

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	HOWARD EUGENE ANDERSON JR.
Credential	:	M.D.
Telephone Number	:	972-780-2730

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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