MEDICARE: RICHARD 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	208600000X	Surgery Physician	G3111	TX
2	2086S0129X	Vascular Surgery Physician	G3111	TX

General Provider Information

NPI Number	:	1689696122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ANDERSON MD

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 414
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-369-5432
Fax Number	:	214-369-5591

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 414
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-369-5432
Fax Number	:	214-369-5591

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/24/2016

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Directions to “ RICHARD ANDERSON MD” Practice Location

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