Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301087092 | MI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 4301087092 | MI |
N | 208200000X | Surgeon | 4301087092 | MI |
N | 208600000X | Surgeon | 4301087092 | MI |
N | 2086S0105X | Surgery of the Hand | 4301087092 | MI |
NPI | 1023080991 |
---|---|
Provider Name | Scott David Burgess |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4834931 | (05) | MI |
I31907 | (02) | MI |