Basic Information
| Provider Information | |||||||||
| NPI: | 1528029063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | LOWELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | APC 7 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104509000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 S ZARZAMORA ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782075209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103587600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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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 | 207W00000X | M5024 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD11210 | RI | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 411309 | 01 | RI | BLUE CROSS AND BLUE SHEILD OF RI | OTHER | 195720102 | 01 | TX | CSHCN | OTHER | 411309 | 01 | RI | BLUE CHIP | OTHER | 8W1155 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 195720101 | 05 | TX | MEDICAID |