Individual
RUSSELL STEVEN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
777 N MAIN ST, TOOELE, UT 84074-1611
(435) 843-2364
(435) 228-0062
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
(435) 743-5591
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5148252-1204
UT
207Q00000X
Family Medicine Physician
5148252-8904
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548407513
—
UT
Enumeration date
01/13/2009
Last updated
08/07/2023
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