Provider Demographics
NPI:1922323864
Name:ANDERSON, MARQUITA (MD)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 LONE STAR RD STE 260
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8754
Mailing Address - Country:US
Mailing Address - Phone:682-341-7330
Mailing Address - Fax:682-341-7332
Practice Address - Street 1:2302 LONE STAR RD STE 260
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8754
Practice Address - Country:US
Practice Address - Phone:682-341-7330
Practice Address - Fax:682-341-7332
Is Sole Proprietor?:No
Enumeration Date:2010-04-04
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9507207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339917201Medicaid
TX370200ZJZLMedicare PIN