MEDICARE: DR. GARRETT K. ANDERSEN M.D.

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	2085B0100X	Body Imaging Physician	K5443	TX
2	2085R0202X	Diagnostic Radiology Physician	K5443	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	K5443	OTHER	TX	TEXAS MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	157799103	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1972579993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT K. ANDERSEN M.D.

Provider Business Mailing Address
First Line	:	8401 DATAPOINT DR
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5900
Country	:	US
Telephone Number	:	210-616-7700
Fax Number	:	210-616-7709

Provider Business Practice Location Address
First Line	:	8401 DATAPOINT DR
Second Line	:	SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-5900
Country	:	US
Telephone Number	:	210-616-7700
Fax Number	:	210-616-7709

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	03/16/2016

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Directions to “ DR. GARRETT K. ANDERSEN M.D.” Practice Location

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