Provider Demographics
NPI:1063629830
Name:ANDERSON, DEAN G (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:G
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:151 W 200 N
Mailing Address - Street 2:ASHLEY REGIONAL MEDICAL CENTER
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-1907
Mailing Address - Country:US
Mailing Address - Phone:435-789-3342
Mailing Address - Fax:435-789-1314
Practice Address - Street 1:151 W 200 N
Practice Address - Street 2:ASHLEY REGIONAL MEDICAL CENTER
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-1907
Practice Address - Country:US
Practice Address - Phone:435-789-3342
Practice Address - Fax:435-789-1314
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-7535207P00000X
UT6972290-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine