Provider Demographics
NPI:1437511912
Name:BURNHAM, BRANT MATTHEW (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:MATTHEW
Last Name:BURNHAM
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 1:828 S 1040 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4614
Mailing Address - Country:US
Mailing Address - Phone:801-980-9444
Mailing Address - Fax:801-224-5204
Practice Address - Street 1:828 S 1040 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-4614
Practice Address - Country:US
Practice Address - Phone:801-980-9444
Practice Address - Fax:801-224-5204
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006775213E00000X
UT11327341-0501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist