Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 5585387-1204 | UT |
Y | 213ES0000X | Sports Medicine | 5585387-1204 | UT |
N | 2081S0010X | Sports Medicine | O-0868 | ID |
N | 213ES0000X | Sports Medicine | O-0868 | ID |
NPI | 1063701217 |
---|---|
Provider Name | Dr. Sean D Anderson |
First Address | Atlanta, GA 30374-1729 |
Second Address | Ogden, UT 84405-7419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2011 |
Last Update Date | 15/03/2021 |