Healthcare Provider Details

I. General information

NPI: 1649920513
Provider Name (Legal Business Name): EMILY MARIE BURSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECHHI DR RM 5N200
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

30 N MARIO CAPECHHI DR RM 5N200
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-6393
  • Fax:
Mailing address:
  • Phone: 801-581-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number14281952-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14281952-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: