Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4423 | AZ |
NPI | 1073791885 |
---|---|
Provider Name | Dr. Mark B Burdorf |
First Address | Scottsdale, AZ 85260-5268 |
Second Address | Scottsdale, AZ 85260-5268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AW2655 | HEALTH NET (01) | AZ |
AZ0930740 | BCBS (01) | AZ |