Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 150123 | MA |
NPI | 1023009990 |
---|---|
Provider Name | Dr. William Judson Burtis |
First Address | Concord, MA 01742-3328 |
Second Address | Concord, MA 01742-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 13/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3148718 | (05) | MA |
D83627 | (02) | MA |