Provider Demographics
NPI:1659403418
Name:ANDERSON GUDERIAN MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:ANDERSON GUDERIAN MEDICAL ASSOCIATION
Other - Org Name:CALDER URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GUDERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-557-4404
Mailing Address - Street 1:1100 GULF FWY S
Mailing Address - Street 2:SIUTE 230
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5153
Mailing Address - Country:US
Mailing Address - Phone:281-557-4404
Mailing Address - Fax:281-557-4443
Practice Address - Street 1:1100 GULF FWY S
Practice Address - Street 2:SIUTE 230
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5153
Practice Address - Country:US
Practice Address - Phone:281-557-4404
Practice Address - Fax:281-557-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG59578Medicare UPIN
TX0077BHMedicare ID - Type Unspecified