Provider Demographics
NPI:1649319500
Name:ANDERSON, ERIC D (MD, FACSC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, FACSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-233-4400
Mailing Address - Fax:801-233-4410
Practice Address - Street 1:5169 COTTONWOOD ST STE 410
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6769
Practice Address - Country:US
Practice Address - Phone:801-266-8850
Practice Address - Fax:801-266-8860
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168407-12052086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07437Medicare UPIN
UT000063135Medicare PIN
UT006902804Medicare PIN