Healthcare Provider Details

I. General information

NPI: 1720349350
Provider Name (Legal Business Name): JAMES D BURT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 CHAMBERS ST
OGDEN UT
84403-4571
US

IV. Provider business mailing address

982 CHAMBERS ST
OGDEN UT
84403-4571
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4105
  • Fax:
Mailing address:
  • Phone: 801-479-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number357477-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: