Provider Demographics
NPI:1285698217
Name:BURST, ANNETTE G (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:G
Last Name:BURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3500 HARRISON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2038
Mailing Address - Country:US
Mailing Address - Phone:801-668-2010
Mailing Address - Fax:801-627-2228
Practice Address - Street 1:3500 HARRISON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2038
Practice Address - Country:US
Practice Address - Phone:801-668-2010
Practice Address - Fax:801-627-2228
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT16899912052083P0500X
IN01023829A2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
123713Medicare UPIN
152680HHMedicare ID - Type Unspecified