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: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 308
PROVO UT
84604-3373
US

IV. Provider business mailing address

1055 N 300 W STE 308
PROVO UT
84604-3373
US

V. Phone/Fax

Practice location:
  • Phone: 385-504-1334
  • Fax: 801-210-5812
Mailing address:
  • Phone: 385-504-1334
  • Fax: 801-210-5812

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 TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6147456-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberO-0961
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: