Provider Demographics
NPI:1740623966
Name:BURT, ASHLEY MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:BURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:877 W MAIN ST STE 603
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6070
Mailing Address - Country:US
Mailing Address - Phone:208-954-8070
Mailing Address - Fax:
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-954-8070
Practice Address - Fax:208-954-8073
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-146532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology