Provider Demographics
NPI:1770545741
Name:NEVIN ANDERSON MD PA
Entity type:Organization
Organization Name:NEVIN ANDERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONDE
Authorized Official - Middle Name:NEVIN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-573-6371
Mailing Address - Street 1:PO BOX 4286
Mailing Address - Street 2:301 E AIRLINE
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3901
Mailing Address - Country:US
Mailing Address - Phone:361-573-6371
Mailing Address - Fax:361-573-7961
Practice Address - Street 1:301 E AIRLINE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3901
Practice Address - Country:US
Practice Address - Phone:361-573-6371
Practice Address - Fax:361-573-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E0785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0075JFOtherBCBS
D74265Medicare UPIN
00859ZMedicare ID - Type UnspecifiedMEDICARE GROUP #FOR BUSIN