Provider Demographics
NPI:1497794150
Name:ANDERSON, CHRISTOPHER K (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 150627
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0627
Mailing Address - Country:US
Mailing Address - Phone:385-492-4930
Mailing Address - Fax:854-924-4493
Practice Address - Street 1:5957 FASHION POINT DR STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:385-492-4930
Practice Address - Fax:385-492-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT184694 1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000011959Medicare PIN