Provider Demographics
NPI:1710071626
Name:ANDERSON, THOMAS S (BSC,RVS,RCS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:BSC,RVS,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2550
Mailing Address - Country:US
Mailing Address - Phone:432-244-9007
Mailing Address - Fax:
Practice Address - Street 1:1906 REDBUD DR
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2550
Practice Address - Country:US
Practice Address - Phone:432-244-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35300246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35300OtherCCI