Individual
DANIEL BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN, CD
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-8413
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
9897134-4901
UT
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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