Provider Demographics
NPI:1619120201
Name:REXFORD K.ANDERSON,JR,M.D.,P.A.
Entity Type:Organization
Organization Name:REXFORD K.ANDERSON,JR,M.D.,P.A.
Other - Org Name:WEST TEXAS NEUROLOGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REXFORD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:325-672-5611
Mailing Address - Street 1:402 CYPRESS ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5139
Mailing Address - Country:US
Mailing Address - Phone:325-672-5611
Mailing Address - Fax:325-672-9241
Practice Address - Street 1:402 CYPRESS ST
Practice Address - Street 2:SUITE 609
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5139
Practice Address - Country:US
Practice Address - Phone:325-672-5611
Practice Address - Fax:325-672-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD49122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00R060Medicare PIN
C12829Medicare UPIN