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NPI Code Detail

MEDICARE: DR. SHANE BLAKE ANDERSON D.O.

MEDICARE: DR. SHANE BLAKE ANDERSON D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician328507-1204UT
2207UN0902XNuclear Imaging & Therapy Physician378NE
3207U00000XNuclear Medicine Physician328507-1204UT

General Provider Information

NPI Number : 1144208661
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE BLAKE ANDERSON D.O.
Provider Business Mailing Address
First Line : 5334 S WOODROW ST STE 100
Second Line :
City : MURRAY
State : UT
Zip : 84107-5838
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5334 S WOODROW ST STE 100
Second Line :
City : MURRAY
State : UT
Zip : 84107-5838
Country : US
Telephone Number : 801-713-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 04/27/2026

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Directions to “ DR. SHANE BLAKE ANDERSON D.O.” Practice Location

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