Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD4750 | HI |
NPI | 1689636953 |
---|---|
Provider Name | Dr. Lawrence Peter Burgess |
First Address | Honolulu, HI 96813-2429 |
Second Address | Honolulu, HI 96813-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04934501 | (05) | HI |
C04304 | (02) | HI |