Basic Information
| Provider Information | |||||||||
| NPI: | 1861539454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | TERRENCE | ||||||||
| MiddleName: | DAMON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15200 SOUTHWEST FWY STE 350 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774783880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137141256 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 SOUTHWEST FWY STE 350 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774783880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137141256 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Q5965 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | Q5965 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q5965 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER |