MEDICARE: DR. JOSEPH ROBERT ANDERSON JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	82-168120-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	030000972	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1720080062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ROBERT ANDERSON JR. M.D.

Provider Business Mailing Address
First Line	:	5929 FASHION POINT DR
Second Line	:	SUITE 101
City	:	OGDEN
State	:	UT
Zip	:	84403-4672
Country	:	US
Telephone Number	:	801-476-0052
Fax Number	:	801-476-0064

Provider Business Practice Location Address
First Line	:	5929 FASHION POINT DR
Second Line	:	SUITE 101
City	:	OGDEN
State	:	UT
Zip	:	84403-4672
Country	:	US
Telephone Number	:	801-476-0052
Fax Number	:	801-476-0064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/11/2011

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