Provider Demographics
NPI:1508916370
Name:ANDERSON, JUSTIN ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ERIC
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUSTIN
Other - Middle Name:ERIC
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4315 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2507
Mailing Address - Country:US
Mailing Address - Phone:806-792-2104
Mailing Address - Fax:
Practice Address - Street 1:4315 28TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2507
Practice Address - Country:US
Practice Address - Phone:806-792-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9125207W00000X
NY237829-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3782OtherBLUE CROSS BLUE SHIELD
TX8H3782OtherBLUE CROSS BLUE SHIELD