Provider Demographics
NPI:1821328451
Name:KENNETH E. ANDERSON JR. M.D. P.A.
Entity Type:Organization
Organization Name:KENNETH E. ANDERSON JR. M.D. P.A.
Other - Org Name:NEW HORIZONS PAIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-893-6000
Mailing Address - Street 1:500 E PEYTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-0200
Mailing Address - Country:US
Mailing Address - Phone:903-893-6000
Mailing Address - Fax:903-868-1802
Practice Address - Street 1:500 E PEYTON ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-0200
Practice Address - Country:US
Practice Address - Phone:903-893-6000
Practice Address - Fax:903-868-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6764207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty