Provider Demographics
NPI:1871541227
Name:ANDERSON, CRAIG W (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOUTH 900 EAST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102
Mailing Address - Country:US
Mailing Address - Phone:801-328-2522
Mailing Address - Fax:801-533-0589
Practice Address - Street 1:756 EAST 12200 SOUTH
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9724
Practice Address - Country:US
Practice Address - Phone:801-328-2522
Practice Address - Fax:801-533-0589
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT163354-1205207Y00000X
UT1633541205207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD20192Medicare UPIN
UT000001285Medicare ID - Type Unspecified