Individual
DR. BLAINE P ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 N 500 E, #260, LOGAN, UT 84341-2408
(435) 753-3400
(435) 787-8887
Mailing address
1300 N 500 E, #260, LOGAN, UT 84341-2408
(435) 753-3400
(435) 787-8887
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
1788161205
UT
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
Primary
1788168905
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003052200
—
ID
Enumeration date
08/30/2006
Last updated
11/10/2016
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