Provider Demographics
NPI:1699060079
Name:BURROW, DAVID NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NATHAN
Last Name:BURROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:750 ROUND VALLEY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7549
Mailing Address - Country:US
Mailing Address - Phone:435-649-7680
Mailing Address - Fax:
Practice Address - Street 1:454 E MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1391
Practice Address - Country:US
Practice Address - Phone:435-657-4400
Practice Address - Fax:801-657-4460
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10272476-1205207R00000X, 2084F0202X, 2084P0800X
AZ622632084F0202X, 2084P0800X
COCDR.00008912084F0202X, 2084P0800X
MT903292084F0202X, 2084P0800X
NV203822084F0202X, 2084P0800X
IDMC-06522084F0202X, 2084P0800X
WY13096C2084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101252940OtherVIRGINIA BOARD OF MEDICINE AND SURGERY
TN707OtherSPECIAL TRAINING LICENSE