Individual
MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1055 N 500 W STE 101, PROVO, UT 84604-3305
(801) 373-4366
(801) 418-0941
Mailing address
PO BOX 27128, ATTN: CREDENTIALING, SALT LAKE CITY, UT 84127-0128
(801) 357-4600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10117275-1206
UT
Other
Enumeration date
10/24/2016
Last updated
04/07/2026
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