Provider Demographics
NPI:1538341201
Name:KEVIN B. ANDERSON, DO, PA
Entity type:Organization
Organization Name:KEVIN B. ANDERSON, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-574-1832
Mailing Address - Street 1:2700 CITIZENS PLZ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5754
Mailing Address - Country:US
Mailing Address - Phone:361-574-1832
Mailing Address - Fax:361-574-1833
Practice Address - Street 1:2700 CITIZENS PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5754
Practice Address - Country:US
Practice Address - Phone:361-574-1832
Practice Address - Fax:361-574-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty