Provider Demographics
NPI:1720080062
Name:ANDERSON, JOSEPH ROBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:ANDERSON
Suffix:JR
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 1:5929 FASHION POINT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4672
Mailing Address - Country:US
Mailing Address - Phone:801-476-0052
Mailing Address - Fax:801-476-0064
Practice Address - Street 1:5929 FASHION POINT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4672
Practice Address - Country:US
Practice Address - Phone:801-476-0052
Practice Address - Fax:801-476-0064
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT82-168120-1205207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030000972OtherRAILROAD MEDICARE
000001638Medicare ID - Type Unspecified
030000972OtherRAILROAD MEDICARE