Healthcare Provider Details

I. General information

NPI: 1639166416
Provider Name (Legal Business Name): DELLRAY H ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7321 BALMER ST
HILL AFB UT
84056-5012
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-5285
  • Fax: 801-586-9722
Mailing address:
  • Phone: 801-777-5285
  • Fax: 801-586-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number174764-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: