Healthcare Provider Details

I. General information

NPI: 1598933020
Provider Name (Legal Business Name): RICHARD E ANDERSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W 1500 N
NEPHI UT
84648-8900
US

IV. Provider business mailing address

PO BOX 581
LEVAN UT
84639-0581
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-9964
  • Fax: 435-843-9907
Mailing address:
  • Phone: 435-843-9964
  • Fax: 435-843-9907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number891810851205
License Number StateUT

VIII. Authorized Official

Name: KAYE PRATT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 435-843-9964