Provider Demographics
NPI:1396937140
Name:ANDERSON, ANTHON E (MD)
Entity type:Individual
Prefix:
First Name:ANTHON
Middle Name:E
Last Name:ANDERSON
Suffix:
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 1:5770 S 250 E STE G50
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6165
Mailing Address - Country:US
Mailing Address - Phone:801-314-4440
Mailing Address - Fax:801-314-4437
Practice Address - Street 1:5770 SO 250 E SUITE G-50
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?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1486651205207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT016477OtherSELECT HEALTH
UTD26551Medicare UPIN