Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 282785-0501 | UT |
NPI | 1053334730 |
---|---|
Provider Name | Dr. Ryan K Anderson |
First Address | Bountiful, UT 84010-7268 |
Second Address | Bountiful, UT 84010-7268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 28/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91268 | (02) | UT |