Provider Demographics
NPI:1922323864
Name:ANDERSON, MARQUITA (MD)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COTTAGE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-5100
Mailing Address - Country:US
Mailing Address - Phone:409-893-2775
Mailing Address - Fax:
Practice Address - Street 1:2965 HARRISON ST
Practice Address - Street 2:SUITE 313
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1100
Practice Address - Country:US
Practice Address - Phone:409-838-4472
Practice Address - Fax:877-769-2234
Is Sole Proprietor?:No
Enumeration Date:2010-04-04
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9507207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339917201Medicaid
TX370200ZJZLMedicare PIN