Provider Demographics
NPI:1083872865
Name:ANDERSON, JANEAR ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANEAR
Middle Name:ROCHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANEAR
Other - Middle Name:ROCHELLE
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-683-3014
Mailing Address - Fax:940-683-3017
Practice Address - Street 1:1903 DOCTORS HOSPITAL DR
Practice Address - Street 2:SUITE 36
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2269
Practice Address - Country:US
Practice Address - Phone:940-683-3014
Practice Address - Fax:940-683-3017
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5532208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX#8ER567OtherBCBSTX
TX326232102Medicaid
TX365118YLH5Medicare PIN