Healthcare Provider Details

I. General information

NPI: 1336070697
Provider Name (Legal Business Name): RYAN K ANDERSON D P M P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 W 7000 S STE 201
WEST JORDAN UT
84084-3556
US

IV. Provider business mailing address

1561 W 7000 S STE 201
WEST JORDAN UT
84084-3556
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-2696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY LOFTHOUSE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 530-925-6027