Provider Demographics
NPI:1679993562
Name:ANDERSON, JESS (DO)
Entity Type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR 3RD FLOOR COTO TOWER
Mailing Address - Street 2:PULMONARY CLINIC
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4505
Mailing Address - Country:US
Mailing Address - Phone:210-916-2153
Mailing Address - Fax:210-916-0709
Practice Address - Street 1:3551 ROGER BROOKE DR APT 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4505
Practice Address - Country:US
Practice Address - Phone:210-916-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1453207RC0200X
TXT2813207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease