Provider Demographics
NPI:1558401919
Name:ANDERS, SUPHITHAYA (MD)
Entity Type:Individual
Prefix:
First Name:SUPHITHAYA
Middle Name:
Last Name:ANDERS
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 1:5770 SO 250 E G50
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-314-4440
Mailing Address - Fax:801-314-4457
Practice Address - Street 1:5770 SO 250 E G50
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-314-4440
Practice Address - Fax:801-314-4437
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47457731205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT47457731202001OtherBCBS
UT107008989102OtherIHC
H20164Medicare UPIN