| Doctor Name: | JEFFERY W ANDERSON |
| NPI Number: | 1255398921 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 325314-1206 |
| Business Practice Address: | 5991 S 3500 W Suite 400 Roy, UT - 840676701 |
| Business Phone Number: | 8017732838 |
| Business Fax Number: | 8017733025 |
| Mailing Address: | 1055 N 500 W, Attn: Credentialing PROVO |
| State: | UT |
| Postal Code: | 846043305 |
| Phone Number: | 8013548225 |
| Fax Number: | 8014180941 |
| NPI Enumeration Date: | 04/27/2006 |
| NPI Last Update Date: | 08/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 325314-1206 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |