Healthcare Provider Details

I. General information

NPI: 1922569672
Provider Name (Legal Business Name): ANDREW H BURGON PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N 2000 W STE 6
FARR WEST UT
84404-9541
US

IV. Provider business mailing address

1761 N 2000 W STE 6
FARR WEST UT
84404-9541
US

V. Phone/Fax

Practice location:
  • Phone: 801-564-1562
  • Fax: 801-689-2594
Mailing address:
  • Phone: 801-564-1562
  • Fax: 801-689-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW HARRIS BURGON
Title or Position: DPM/OWNER
Credential: DPM
Phone: 435-760-7313