Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 26-3054460 | CO |
NPI | 1386995082 |
---|---|
Provider Name | Vernon Burgess |
First Address | Colorado Springs, CO 80916-2695 |
Second Address | Colorado Springs, CO 80903-3479 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 21/09/2012 |