Individual
BRADLEY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1025 E 3300 S STE B, SALT LAKE CITY, UT 84106
(801) 476-0494
Mailing address
1025 E 3300 S, SALT LAKE CITY, UT 84106-2849
(801) 476-0494
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301100655
MI
207W00000X
Ophthalmology Physician
Primary
10179215-1205
UT
207W00000X
Ophthalmology Physician
M-13380
ID
Other
Enumeration date
06/21/2012
Last updated
02/24/2021
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