Healthcare Provider Details

I. General information

NPI: 1083328850
Provider Name (Legal Business Name): ANTHONY CHARLES ALDER PA-C, DMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 W 4100 S STE 107
WEST VALLEY UT
84120-6063
US

IV. Provider business mailing address

3725 W 4100 S STE 107
WEST VALLEY CITY UT
84120-6063
US

V. Phone/Fax

Practice location:
  • Phone: 385-402-7500
  • Fax:
Mailing address:
  • Phone: 385-402-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: