=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407296189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW HARRIS BURGON D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2013
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1761 N 2000 W STE 6
-----------------------------------------------------
City | FARR WEST
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-9541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-564-1562
-----------------------------------------------------
Fax | 801-689-2594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2499 N 450 W
-----------------------------------------------------
City | HARRISVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84414-7209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-760-7313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 41000293A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------