Provider Demographics
NPI:1508356544
Name:ANDERSON, DAVID AUSTIN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
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 1:2245 N 400 E STE 201
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1891
Mailing Address - Country:US
Mailing Address - Phone:435-787-7001
Mailing Address - Fax:801-216-8357
Practice Address - Street 1:2245 N 400 E STE 201
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1891
Practice Address - Country:US
Practice Address - Phone:435-787-7001
Practice Address - Fax:801-216-8357
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13856506207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology