Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036145258 | IL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | DO-05180 | IA |
NPI | 1740629906 |
---|---|
Provider Name | Jay Burmeister |
First Address | Davenport, IA 52807-3471 |
Second Address | Davenport, IA 52807-3471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 15/09/2020 |