Healthcare Provider Details

I. General information

NPI: 1124681374
Provider Name (Legal Business Name): NEYSI ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8TH AVE C ST
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-4384
  • Fax:
Mailing address:
  • Phone: 801-507-4384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2035
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number134208
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72007
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0069015
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0447525
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3236
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number14028875-1235
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: