Provider Demographics
NPI:1497032080
Name:ANDERSON, MARY ALICE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ALICE
Other - Last Name:NESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 E FRANKLIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1206
Mailing Address - Country:US
Mailing Address - Phone:915-834-7680
Mailing Address - Fax:915-834-7800
Practice Address - Street 1:401 E FRANKLIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1206
Practice Address - Country:US
Practice Address - Phone:915-834-7680
Practice Address - Fax:915-834-7800
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD343412083A0100X
TXP05362083P0901X
NV117072083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine