Individual
JACOB GLEN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
81 N MARIO CAPECCHI DR # 4B056, SALT LAKE CITY, UT 84113-1125
(801) 581-2121
Mailing address
81 N MARIO CAPECCHI DR # 4B056, SALT LAKE CITY, UT 84113-1125
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
2080P0216X
Pediatric Rheumatology Physician
Primary
14210863-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
—
Other
Enumeration date
05/02/2022
Last updated
03/19/2025
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