Provider Demographics
NPI:1548252885
Name:WASHBURN, MICHAEL D (MD, PC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2255 N 1700 W
Mailing Address - Street 2:100
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1140
Mailing Address - Country:US
Mailing Address - Phone:801-773-0690
Mailing Address - Fax:801-773-0697
Practice Address - Street 1:2255 N 1700 W
Practice Address - Street 2:100
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-773-0690
Practice Address - Fax:801-773-0697
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT159147-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005319Medicare ID - Type Unspecified
UTE00017Medicare UPIN