Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 28159755A | IN |
NPI | 1013164425 |
---|---|
Provider Name | Dawn M Burgess |
First Address | Evansville, IN 47714-1627 |
Second Address | Evansville, IN 47714-1627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 27/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000085654 | INDIANA BLUE CROSS BLUE SHIELD (01) | IN |
000000085654 | KENTUCKY BLUE CROSS BLUE SHIELD (01) | KY |
188985 | HEALTHLINK PPO (01) | KY |
221001 | WELBORN HEALTHCARE (01) | IN |
4116028 | AETNA (01) | IN |
91107974 | ILLINOIS BLUE CROSS BLUE SHIELD (01) | IL |