Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4820 | SD |
NPI | 1013961978 |
---|---|
Provider Name | Robert Burgess |
First Address | Rapid City, SD 57701-5462 |
Second Address | Rapid City, SD 57701-7756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 18/05/2012 |