Provider Demographics
NPI:1548342504
Name:ANDERS, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1803
Mailing Address - Country:US
Mailing Address - Phone:903-663-6332
Mailing Address - Fax:903-663-6347
Practice Address - Street 1:2903 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1803
Practice Address - Country:US
Practice Address - Phone:903-663-6332
Practice Address - Fax:903-663-6347
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650433OtherBLUE CROSS BLUE SHIELD
TX738915OtherBLUE LINK BC/BS
TX087733401Medicaid
TX650433OtherBLUE CROSS BLUE SHIELD
TX675553Medicare Oscar/Certification