Provider Demographics
NPI:1871661124
Name:ANDERSON, BRADY E (MD)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-244-0111
Mailing Address - Fax:512-244-2479
Practice Address - Street 1:1180 SETON PKWY STE 220
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6179
Practice Address - Country:US
Practice Address - Phone:512-504-0877
Practice Address - Fax:512-504-0864
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0343208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196312601Medicaid
TX7595865OtherAETNA
TXP00666901Medicare PIN
TX8L0426Medicare PIN