Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-30950 | CA |
NPI | 1528229218 |
---|---|
Provider Name | Dr. Richard Ward Burg |
First Address | Oakland, CA 94609-1329 |
Second Address | Oakland, CA 94609-1329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 27/12/2011 |