Provider Demographics
NPI:1891043147
Name:ANDERSON, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22703
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-2703
Mailing Address - Country:US
Mailing Address - Phone:713-572-3937
Mailing Address - Fax:713-973-2754
Practice Address - Street 1:1213 HERMANN DR STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7000
Practice Address - Country:US
Practice Address - Phone:713-572-3937
Practice Address - Fax:713-521-1264
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8212207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EL738OtherBCBS (MDACC)
TX336800301 (MDACC)Medicaid
TX351441ZG4GMedicare PIN
TX351441YKQH (MDACC)Medicare PIN