Provider Demographics
NPI:1275528986
Name:ANDERSON, STEVEN JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 E 3900 S
Mailing Address - Street 2:STE B275
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1216
Mailing Address - Country:US
Mailing Address - Phone:801-262-2452
Mailing Address - Fax:801-262-1028
Practice Address - Street 1:1151 E 3900 S
Practice Address - Street 2:STE B275
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1216
Practice Address - Country:US
Practice Address - Phone:801-262-2452
Practice Address - Fax:801-262-1028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1562051205207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D20420Medicare UPIN
UT04859Medicare ID - Type Unspecified