Provider Demographics
NPI:1245240290
Name:ANDERSON, JAMES E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:900 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4681
Mailing Address - Country:US
Mailing Address - Phone:817-885-7442
Mailing Address - Fax:817-885-7443
Practice Address - Street 1:900 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4537
Practice Address - Country:US
Practice Address - Phone:817-885-7442
Practice Address - Fax:817-885-7443
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9600208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1716631-03Medicaid
P00254142OtherRAILROAD MEDICARE