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Individual

DR. BRENT RAY BURDETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5929 FASHION POINT DR, STE 101, SOUTH OGDEN, UT 84403-4672
(801) 476-0052
(801) 476-0064
Mailing address
5929 FASHION POINT DR, STE 101, SOUTH OGDEN, UT 84403-4672
(801) 476-0052
(801) 476-0064

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
75-158533-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
030001482
RAILROAD MEDICARE
Enumeration date
06/01/2005
Last updated
06/23/2010
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