Provider Demographics
NPI:1245228923
Name:ANDERSON, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N STANTON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2511
Mailing Address - Country:US
Mailing Address - Phone:915-271-4569
Mailing Address - Fax:915-351-0086
Practice Address - Street 1:2930 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2511
Practice Address - Country:US
Practice Address - Phone:915-271-4569
Practice Address - Fax:915-351-0086
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7869207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123025202Medicaid
TX050057555OtherRR MEDICARE
TX123025202Medicaid