Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2010021895 | MO |
NPI | 1174870174 |
---|---|
Provider Name | Dr. Emily Jane Burgoon |
First Address | Sedona, AZ 86351-8806 |
Second Address | Sedona, AZ 86351-8806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 11/11/2015 |