MEDICARE: DR. TAYLOR ROBERT BURNHAM D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	10579226-1204	UT

General Provider Information

NPI Number	:	1841647377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR ROBERT BURNHAM D.O

Provider Business Mailing Address
First Line	:	30 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2409
Country	:	US
Telephone Number	:	801-585-2589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	12/03/2021

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