Provider Demographics
NPI:1851330146
Name:ANDERSON, MARTHA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4099 MCEWEN RD
Mailing Address - Street 2:SUITE700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5030
Mailing Address - Country:US
Mailing Address - Phone:214-630-1105
Mailing Address - Fax:214-630-0810
Practice Address - Street 1:4099 MCEWEN RD
Practice Address - Street 2:SUITE700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5030
Practice Address - Country:US
Practice Address - Phone:214-630-1105
Practice Address - Fax:214-630-0810
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD69281744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC12823Medicare UPIN
TNGU81Medicare UPIN