Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 39199 | CO |
NPI | 1033109699 |
---|---|
Provider Name | Stephen L Burgert |
First Address | Loveland, CO 80537-5161 |
Second Address | Loveland, CO 80537-5161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 14/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123408100 | (05) | WY |
43601049 | (05) | CO |
84081574413 | (05) | NE |
A07114 | (02) | CO |
P00382854 | MEDICARE RAILROAD (01) |