Provider Demographics
NPI:1396825006
Name:ANDERSON, HOWARD EUGENE JR (MD)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:EUGENE
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1800 WINDMILL HILL LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2768
Mailing Address - Country:US
Mailing Address - Phone:214-789-6568
Mailing Address - Fax:972-780-2796
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:SUITE 640
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-4535
Practice Address - Fax:214-943-8213
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103405002Medicaid
TX82V279Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TX103405002Medicaid