MEDICARE: NEVIN ANDERSON MD 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	207Q00000X	Family Medicine Physician	E0785

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0075JF	OTHER		BCBS

General Provider Information

NPI Number	:	1770545741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVIN ANDERSON MD PA

Provider Business Mailing Address
First Line	:	PO BOX 4286
Second Line	:	301 E AIRLINE
City	:	VICTORIA
State	:	TX
Zip	:	77901-3901
Country	:	US
Telephone Number	:	361-573-6371
Fax Number	:	361-573-7961

Provider Business Practice Location Address
First Line	:	301 E AIRLINE
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-3901
Country	:	US
Telephone Number	:	361-573-6371
Fax Number	:	361-573-7961

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CONDE NEVIN ANDERSON JR.
Credential	:	MD
Telephone Number	:	361-573-6371

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/12/2007

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