Provider Demographics
NPI:1114087079
Name:TUVESON, ANNE T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:T
Last Name:TUVESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1531
Mailing Address - Country:US
Mailing Address - Phone:972-271-4141
Mailing Address - Fax:972-278-8691
Practice Address - Street 1:3310 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1531
Practice Address - Country:US
Practice Address - Phone:972-271-4141
Practice Address - Fax:972-278-8691
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300420207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137AFOtherBLUE CROSS PROV ID
NCI16342Medicare UPIN
NC137AFOtherBLUE CROSS PROV ID