Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 171739-1202 | UT |
NPI | 1316027824 |
---|---|
Provider Name | Dr. Thomas W Anderson |
First Address | Salt Lake City, UT 84117-4233 |
Second Address | Salt Lake City, UT 84117-4233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |