Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101030765 | VA |
NPI | 1043262553 |
---|---|
Provider Name | Dr. John Gordon Burch |
First Address | Roanoke, VA 24018-0620 |
Second Address | Roanoke, VA 24018-0612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 28/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006180892 | (05) | VA |
B07692 | (02) | VA |