Provider Demographics
NPI:1508811092
Name:EDSON, ALLAN CURTIS (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:CURTIS
Last Name:EDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ALLAN
Other - Middle Name:CURTIS
Other - Last Name:EDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-294-5224
Mailing Address - Fax:801-294-5269
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE 207
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-294-5224
Practice Address - Fax:801-294-5269
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349532-1204207Q00000X
UT3495321204207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB84818Medicare UPIN
UT000012172Medicare ID - Type Unspecified