Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 1788161205 | UT |
N | 208600000X | Surgeon | 1788161205 | UT |
Y | 2082S0105X | Plastic Hand Surgeon | 1788168905 | UT |
NPI | 1538279609 |
---|---|
Provider Name | Dr. Blaine P Andersen |
First Address | Logan, UT 84341-2408 |
Second Address | Logan, UT 84341-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003052200 | (05) | ID |
U000004560 | (02) | UT |