Healthcare Provider Details

I. General information

NPI: 1508569179
Provider Name (Legal Business Name): ALEXA FISHBURN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E 11400 S
SANDY UT
84094-6946
US

IV. Provider business mailing address

955 E 11400 S
SANDY UT
84094-6946
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-0030
  • Fax:
Mailing address:
  • Phone: 801-571-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number141310081204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: