Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6443959-1202 | UT |
NPI | 1083010276 |
---|---|
Provider Name | Dr. Jared Anderson |
First Address | Salt Lake City, UT 84117-4901 |
Second Address | Salt Lake City, UT 84117-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 14/11/2014 |