Healthcare Provider Details

I. General information

NPI: 1508811092
Provider Name (Legal Business Name): ALLAN CURTIS EDSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALLAN CURTIS EDSON D.O.

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MEDICAL DR SUITE 207
BOUNTIFUL UT
84010-4945
US

IV. Provider business mailing address

425 MEDICAL DR SUITE 207
BOUNTIFUL UT
84010-4945
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-5224
  • Fax: 801-294-5269
Mailing address:
  • Phone: 801-294-5224
  • Fax: 801-294-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3495321204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number349532-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: