Provider Demographics
NPI:1558617464
Name:ANDERSON, CASEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE
Mailing Address - Street 2:ROOM 315
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163
Mailing Address - Country:US
Mailing Address - Phone:901-448-1350
Mailing Address - Fax:
Practice Address - Street 1:415 E SOUTHLAKE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6279
Practice Address - Country:US
Practice Address - Phone:817-416-8080
Practice Address - Fax:817-421-8327
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program