Provider Demographics
NPI:1407296189
Name:BURGON, ANDREW HARRIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HARRIS
Last Name:BURGON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 N 450 W
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7209
Mailing Address - Country:US
Mailing Address - Phone:435-760-7313
Mailing Address - Fax:
Practice Address - Street 1:1761 N 2000 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9541
Practice Address - Country:US
Practice Address - Phone:435-760-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000293A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9715370-0501OtherMEDICAL LICENSE