Healthcare Provider Details

I. General information

NPI: 1932465689
Provider Name (Legal Business Name): BRIAN L ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W 1500 N
NEPHI UT
84648-8900
US

IV. Provider business mailing address

48 W 1500 N
NEPHI UT
84648-8900
US

V. Phone/Fax

Practice location:
  • Phone: 435-623-3202
  • Fax:
Mailing address:
  • Phone: 435-623-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036148825
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number27662
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025035350
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number12900579-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: