Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 0415409 | KS |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | R5304 | MO |
NPI | 1871579037 |
---|---|
Provider Name | Nathan David Burroughs |
First Address | Kansas City, MO 64155-2262 |
Second Address | Kansas City, MO 64155-2262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201188521 | (05) | MO |
C51464 | (02) |