Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | Q5965 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q5965 | TX |
NPI | 1861539454 |
---|---|
Provider Name | Terrence Damon Anderson |
First Address | Missouri City, TX 77459-1488 |
Second Address | Sugar Land, TX 77478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q5965 | TEXAS MEDICAL LICENSE (01) | TX |