Provider Demographics
NPI:1598933020
Name:RICHARD E ANDERSON MD PC
Entity Type:Organization
Organization Name:RICHARD E ANDERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-843-9964
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:LEVAN
Mailing Address - State:UT
Mailing Address - Zip Code:84639-0581
Mailing Address - Country:US
Mailing Address - Phone:435-843-9964
Mailing Address - Fax:435-843-9907
Practice Address - Street 1:48 W 1500 N
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-8900
Practice Address - Country:US
Practice Address - Phone:435-843-9964
Practice Address - Fax:435-843-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT891810851205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty