Provider Demographics
NPI:1659353001
Name:ANZALDUA, JOE A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:A
Last Name:ANZALDUA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:A
Other - Last Name:ANZALDUA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4911 SAND HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5320
Mailing Address - Country:US
Mailing Address - Phone:281-238-7870
Mailing Address - Fax:281-265-2101
Practice Address - Street 1:6350 HIGHWAY 90A
Practice Address - Street 2:STE 600
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2021
Practice Address - Country:US
Practice Address - Phone:281-265-7000
Practice Address - Fax:281-265-2101
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2357OtherBCBS
C12901Medicare UPIN
TX8A2357OtherBCBS