Provider Demographics
NPI:1871661124
Name:ANDERSON, BRADY E (MD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:E
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 1:7200 WYOMING SPGS
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-244-0111
Mailing Address - Fax:512-244-2479
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:SUITE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-244-0111
Practice Address - Fax:512-244-2479
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7595865OtherAETNA
TX196312601Medicaid
TXP00666901Medicare PIN
TX8L0426Medicare PIN