Basic Information
| Provider Information | |||||||||
| NPI: | 1215145776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ORSON | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY | ||||||||
| Address2: | SUITE 15 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794073544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1104 N AVENUE S | ||||||||
| Address2: | |||||||||
| City: | POST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793562115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064952853 | ||||||||
| FaxNumber: | 8067953576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 06/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A41825 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | J2480 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0419281 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.