Corey Rawlins Anderson, D.S.S., M.S.
Individual provider Active NPI Periodontics · Jbsa Lackland, TX
NPI 1932183282 · NPPES record last updated Jul 20, 2023
Key facts
- NPI
- 1932183282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 4736830-9922 (UT)
- Practice address
- 1615 Truemper St BLDG 6418
Jbsa Lackland, TX 78236-5511 - Phone
- (757) 913-2847
- NPI assigned
- Nov 30, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4736830-9922 | UT | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 4736830-9922 | UT | Yes |
Addresses
Primary practice location
1615 Truemper St BLDG 6418
Jbsa Lackland, TX 78236-5511
Mailing address
381 TRS
BLDG 903
Ft Sam Houston, TX 78234
Phone (210) 808-1121
Other practice location 1
221 3rd St W Bldg 1040
Jbsa Randolph, TX 78150-4800
Phone (210) 652-8544
Other providers in Jbsa Lackland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.