Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | UO-4707 | FL |
NPI | 1013390368 |
---|---|
Provider Name | Dr. Justin Dana Burkholder |
First Address | Miami Beach, FL 33141-4709 |
Second Address | Miami Beach, FL 33140-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2015 |
Last Update Date | 06/07/2015 |