Healthcare Provider Details

I. General information

NPI: 1932293727
Provider Name (Legal Business Name): JASON L ANDERSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 S 1680 W
OREM UT
84058-4939
US

IV. Provider business mailing address

1215 S 1680 W
OREM UT
84058-4939
US

V. Phone/Fax

Practice location:
  • Phone: 385-277-0900
  • Fax: 801-465-3267
Mailing address:
  • Phone: 385-277-0900
  • Fax: 801-465-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number6147456-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberO-0961
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number6147456-1204
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: