Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35305 | WI |
Y | 208600000X | Surgeon | 35305 | WI |
N | 2086S0127X | Trauma Surgeon | 35305 | WI |
N | 2086S0129X | Vascular Surgeon | 35305 | WI |
N | 208C00000X | Colorectal Surgeon | 35305 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 35305 | WI |
NPI | 1124078662 |
---|---|
Provider Name | Jeffrey Scott Burkett |
First Address | Neenah, WI 54956-2763 |
Second Address | Neenah, WI 54956-2763 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32014100 | (05) | WI |