Deryk L Anderson, MD
Individual provider Active NPI Family Medicine Physician · West Jordan, UT
NPI 1649385154 · NPPES record last updated Sep 28, 2007
Key facts
- NPI
- 1649385154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 881785201205 (UT)
- Practice address
- 2655 W 9000 S
West Jordan, UT 84088-8542 - Phone
- (801) 568-9933
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 881785201205 | UT | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 881785201205 | UT | Yes |
Addresses
Primary practice location
2655 W 9000 S
West Jordan, UT 84088-8542
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 233-4400
Other providers in West Jordan, UT
- Dana A Andersen
- Mayson Andersen
- Alyssa Anderson
- Ashley Leann Anderson
- Brisma Paulina Anderson
- Kristen Ann Anderson
- Megan Danielle Anderson
- Melissa Dawn Anderson
- Peter Corless Anderson
- Roberta Francis Anderson
All providers in West Jordan, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.