Provider Demographics
NPI:1285814244
Name:ANDERSON, CODY N (MD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:N
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:512-551-0634
Practice Address - Street 1:12201 RENFERT WAY
Practice Address - Street 2:SUITE 115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:512-551-0375
Practice Address - Fax:512-551-0634
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN0606207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196190601Medicaid
TX196190607Medicaid
TX8BE151OtherBCBS
TXP02028499OtherMEDICARE RAIL ROAD
TX327352YSWMOtherMEDICARE