MEDICARE: DR. KORY T ANDERSON 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	207R00000X	Internal Medicine Physician	3083260-1205	UT
2	208M00000X	Hospitalist Physician	3083260-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00642566	OTHER	UT	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1922137140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KORY T ANDERSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-387-3364
Fax Number	:	801-475-1621

Provider Business Practice Location Address
First Line	:	4401 HARRISON BLVD
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-3195
Country	:	US
Telephone Number	:	801-387-3364
Fax Number	:	801-475-1621

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	04/06/2026

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