MEDICARE: DR. DELLRAY H ANDERSON M.D.

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
1	207Q00000X	Family Medicine Physician	174764-1205	UT

General Provider Information

NPI Number	:	1639166416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELLRAY H ANDERSON M.D.

Provider Business Mailing Address
First Line	:	7321 BALMER ST
Second Line	:
City	:	HILL AFB
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-5285
Fax Number	:	801-586-9722

Provider Business Practice Location Address
First Line	:	7321 BALMER ST
Second Line	:
City	:	HILL AFB
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-777-5285
Fax Number	:	801-586-9722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	04/24/2013

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