Individual
JACOB REX ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(623) 561-1000
Mailing address
3971 JOSHUA LN, IDAHO FALLS, ID 83401-1778
(208) 881-7679
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/26/2025
Last updated
03/26/2025
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