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General NPI Number Information
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NPI Number | 1043444516
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Entity Type | Individual
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Provider Name | PETER CORLESS ANDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 3584 W 9000 S STE. 311
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City | WEST JORDAN
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State | UT
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Zip | 84088-5710
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Country | US
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Telephone | 801-566-8304
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Fax |
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Provider Business Mailing Address
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Address Line | 3584 W 9000 S STE. 311
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City | WEST JORDAN
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State | UT
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Zip | 84088-5710
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Country | US
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Telephone | 801-566-8304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 5366856-1205
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License Number State | UT
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