Provider Demographics
NPI:1922569672
Name:ANDREW H BURGON PODIATRY LLC
Entity Type:Organization
Organization Name:ANDREW H BURGON PODIATRY LLC
Other - Org Name:SUMMIT FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BURGON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-760-3713
Mailing Address - Street 1:1761 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9541
Mailing Address - Country:US
Mailing Address - Phone:801-564-1562
Mailing Address - Fax:801-689-2594
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:015-641-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty