Healthcare Provider Details

I. General information

NPI: 1639200215
Provider Name (Legal Business Name): RYAN K ANDERSON D P M P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 W 750 S STE 200
BOUNTIFUL UT
84010-7281
US

IV. Provider business mailing address

434 W ASCENSION WAY STE 425
MURRAY UT
84123-3102
US

V. Phone/Fax

Practice location:
  • Phone: 206-703-2204
  • Fax: 801-397-1938
Mailing address:
  • Phone: 206-703-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: RYAN K ANDERSON
Title or Position: SOLE OWNER
Credential: DPM
Phone: 206-703-2204