Russell Steven Anderson, D.O.
Family Medicine in Tooele, UT. Individual provider (NPI-1).
NPI number1548407513
StatusActive
Last updated in NPPESAug 7, 2023
Details
- NPI
- 1548407513
- Entity type
- Individual (NPI-1)
- Name
- Russell Steven Anderson
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 13, 2009
- Certification date
- Aug 7, 2023
- Last updated
- Aug 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 5148252-1204 | UT | Yes |
| 207Q00000X | Family Medicine | 5148252-8904 | UT |
Practice location
777 N Main StTooele, UT 84074-1611
Phone 435-843-2364 · Fax 435-228-0062
Mailing address
Po Box 30180Salt Lake City, UT 84130-0180
Phone 435-743-5591
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