Provider Demographics
NPI:1073157376
Name:FLEURY, ANILAWAN SMITTHIMEDHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANILAWAN
Middle Name:SMITTHIMEDHIN
Last Name:FLEURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 S WILBUR LN
Mailing Address - Street 2:
Mailing Address - City:S SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1259
Mailing Address - Country:US
Mailing Address - Phone:301-332-7000
Mailing Address - Fax:
Practice Address - Street 1:100 N MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT0008442085N0700X, 2085N0904X, 2085P0229X, 2085R0204X
UT13166410-12052085N0904X, 2085R0202X, 2085R0204X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology