Provider Demographics
NPI:1144330648
Name:ANDERSON, CHAD W (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1811 W ROYAL HUNTE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8274
Mailing Address - Country:US
Mailing Address - Phone:435-586-1131
Mailing Address - Fax:435-865-1121
Practice Address - Street 1:1811 W ROYAL HUNTE DR STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8274
Practice Address - Country:US
Practice Address - Phone:435-586-1131
Practice Address - Fax:435-865-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290405-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF99971Medicare UPIN
UT000011497Medicare ID - Type Unspecified
UT000055971Medicare UPIN