Provider Demographics
NPI:1528029063
Name:ANDERSON, KENT LOWELL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:LOWELL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:APC 7
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:701 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5209
Practice Address - Country:US
Practice Address - Phone:210-358-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5024207W00000X
RIMD11210207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411309OtherBLUE CROSS AND BLUE SHEILD OF RI
TX195720102OtherCSHCN
RI411309OtherBLUE CHIP
TX8W1155OtherBLUE CROSS BLUE SHIELD
TX195720101Medicaid
TX8W1155OtherBLUE CROSS BLUE SHIELD
TX8L11117Medicare PIN