Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 34002794B | OH |
N | 111NI0900X | Internist | 34002794B | OH |
Y | 207RR0500X | Rheumatology | 34002794B | OH |
NPI | 1093808123 |
---|---|
Provider Name | Scott Burg |
First Address | Cleveland, OH 44194-0711 |
Second Address | Mayfield Hts, OH 44124-4071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 15/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03563 | (02) |