Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 15592 | MA |
NPI | 1144347295 |
---|---|
Provider Name | Dr. Donald A Burgoyne |
First Address | Plymouth, MA 02360-2400 |
Second Address | Plymouth, MA 02360-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XO4622 | BCBS (01) | MA |