Individual
KIRK R ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
306 RIVER BEND LN, PROVO, UT 84604-5625
(801) 226-8880
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 429-8000
(801) 429-8150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1621571205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0358
DMBA
UT
01
—
04-00306
UNITED HEALTHCARE
UT
01
—
107006625101
IHC HEALTHPLANS
UT
01
—
110037852
PALMETTO GBA
UT
01
—
14053
PEHP
UT
05
—
870281028000
—
UT
01
—
870281028AN1
EMIA
UT
01
—
QM0000000034
ALTIUS
UT
Enumeration date
05/04/2006
Last updated
01/11/2010
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