Provider Demographics
NPI:1760612410
Name:ANDERSON, JOHN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 LOOP 337 # A
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3556
Mailing Address - Country:US
Mailing Address - Phone:830-625-1786
Mailing Address - Fax:830-606-7546
Practice Address - Street 1:901 LOOP 337 # A
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3556
Practice Address - Country:US
Practice Address - Phone:830-625-1786
Practice Address - Fax:830-606-7546
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1158207N00000X
GA003606207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology