Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | ME61835 | FL |
Y | 208000000X | Pediatrician | ME0061835 | FL |
NPI | 1336212026 |
---|---|
Provider Name | Dr. Elioe Burgos |
First Address | Daytona Beach, FL 32114-2709 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370467000 | (05) | FL |
F31798 | (02) | FL |
ME61835 | STATE MEDICAL LICENSE (01) | FL |