Healthcare Provider Details

I. General information

NPI: 1710906441
Provider Name (Legal Business Name): RICHARD E. ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
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 Number181085-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: