Provider Demographics
NPI:1669556056
Name:ANDERSON, MICHAEL ALAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
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 1:5959 SOUTH STAPLES STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3846
Mailing Address - Country:US
Mailing Address - Phone:361-500-4949
Mailing Address - Fax:361-500-4954
Practice Address - Street 1:5959 SOUTH STAPLES STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3846
Practice Address - Country:US
Practice Address - Phone:361-500-4949
Practice Address - Fax:361-500-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL59752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00783PMedicare ID - Type Unspecified
TX158643003Medicare ID - Type Unspecified
TXH86672Medicare UPIN
TX8F8336Medicare PIN