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General NPI Number Information
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NPI Number | 1467454918
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Entity Type | Individual
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Provider Name | LAURENCE S BURDETT MD, PC
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 3480 WASHINGTON BLVD STE 105
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City | OGDEN
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State | UT
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Zip | 84401-4149
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Country | US
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Telephone | 801-392-0385
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Fax | 801-393-3334
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Provider Business Mailing Address
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Address Line | PO BOX 837
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City | OGDEN
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State | UT
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Zip | 84402-0837
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Country | US
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Telephone | 801-392-0402
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Fax | 801-393-3334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3404331205
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License Number State | UT
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