Provider Demographics
NPI:1366452203
Name:ANDERSON, AMY STEVENS (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:STEVENS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUIE 380
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-730-6000
Mailing Address - Fax:214-730-6003
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 380
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-730-6000
Practice Address - Fax:214-730-6003
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87X755OtherBCBS
TX105305001Medicaid
TX87X755OtherBCBS
TX110126733Medicare PIN
TX87X755Medicare PIN