Provider Demographics
NPI:1962517961
Name:ANDERTON, BARRY J (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:ANDERTON
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 1:425 LAKEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3303
Mailing Address - Country:US
Mailing Address - Phone:801-451-6200
Mailing Address - Fax:
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-993-9551
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167359-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2000040OtherUNITED HEALTHCARE
UT24131OtherPEHP
UT870280408AN1OtherEDUCATORS MUTUAL
UT107006364101OtherIHC
UTPRA01555OtherMOLINA
UTQM0000049505OtherALTIUS
MT401765Medicaid
UT416930OtherDESERET MUTUAL
AZ729535Medicaid
UT2804OtherHEALTHY U
UT2000040OtherUNITED HEALTHCARE