Organization
REFINE THE BODY INC
Active
Other names
Blaine P. Andersen, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE P ANDERSEN MD (PHYSICIAN)
(435) 753-3400
Entity
Organization
Contact information
Practice address
1300 N 500 E STE 260, LOGAN, UT 84341-2417
(435) 753-3400
Mailing address
1300 N 500 E STE 260, LOGAN, UT 84341-2417
(435) 753-3400
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
1788161205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528645618002
—
UT
Enumeration date
01/18/2017
Last updated
01/18/2017
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