Provider Demographics
NPI:1861553067
Name:ANDERSON, SAUNDRA RAE (DO)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:RAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:210 NELSON STREET
Mailing Address - Street 2:STE C
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-2917
Mailing Address - Country:US
Mailing Address - Phone:361-293-7061
Mailing Address - Fax:361-293-7892
Practice Address - Street 1:1200 CARL RAMERT DR
Practice Address - Street 2:STE D
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-4868
Practice Address - Country:US
Practice Address - Phone:361-293-7061
Practice Address - Fax:361-293-7892
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2021-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130794412Medicaid
613912Medicare PIN
TXF84120Medicare UPIN