Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | N0607 | TX |
NPI | 1144267766 |
---|---|
Provider Name | Dr. Larry D Anderson JR. |
First Address | Dallas, TX 75284-7208 |
Second Address | Dallas, TX 75235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 22/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8455032 | (05) | WA |
H41158 | (02) |