Provider Demographics
NPI:1508945783
Name:ANDERSEN, H. R (DPM)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:R
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5412
Mailing Address - Country:US
Mailing Address - Phone:979-836-1111
Mailing Address - Fax:979-836-3600
Practice Address - Street 1:601 MEDICAL PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5412
Practice Address - Country:US
Practice Address - Phone:979-836-1111
Practice Address - Fax:979-836-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0312213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039733302Medicaid
TX613368Medicare PIN