Provider Demographics
NPI:1275514010
Name:ANDERSON, MICHAEL JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:JAMES
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:ATTN: GERIATRICS CLINIC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-794-7375
Mailing Address - Fax:713-794-8678
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:ATTN: GERIATRICS CLINIC
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:713-794-8678
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1057637363A00000X
TXPA04245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant