Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 10764222-1204 | UT |
N | 208000000X | Pediatrician | 036-137661 | IL |
NPI | 1922363001 |
---|---|
Provider Name | Dr. Joshua Graham Burkhardt |
First Address | Provo, UT 84604-3305 |
Second Address | Salem, UT 84653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036137661 | (05) | IL |