Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D3131 | TX |
NPI | 1043289614 |
---|---|
Provider Name | Dr. H Allen Anderson |
First Address | San Angelo, TX 76904-7610 |
Second Address | San Angelo, TX 76904-6884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
821826 | BLUE CROSS/BLUE SHIELD TX (01) | |
C12849 | (02) | TX |