Provider Demographics
NPI:1770524795
Name:ANDERSON, DAVID K (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1790 N STATE STREET
Mailing Address - Street 2:UHS OF TIMPANOGOS
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2028
Mailing Address - Country:US
Mailing Address - Phone:801-224-8255
Mailing Address - Fax:801-224-8301
Practice Address - Street 1:1790 N STATE STREET
Practice Address - Street 2:UHS OF TIMPANOGOS
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2028
Practice Address - Country:US
Practice Address - Phone:801-224-8255
Practice Address - Fax:801-224-8301
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1815081205207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD0283Medicaid
UTD0283Medicaid
E56832Medicare UPIN
UTD0283Medicaid
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