Healthcare Provider Details

I. General information

NPI: 1871541227
Provider Name (Legal Business Name): CRAIG W ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 EAST 12200 SOUTH
DRAPER UT
84020-9724
US

IV. Provider business mailing address

22 SOUTH 900 EAST
SALT LAKE CITY UT
84102
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-2522
  • Fax: 801-533-0589
Mailing address:
  • Phone: 801-328-2522
  • Fax: 801-533-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number163354-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1633541205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: