1689676363 NPI number — DR. STUART KEVIN BURGESS M.D.

Table of content: DR. STUART KEVIN BURGESS M.D. (NPI 1689676363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689676363 NPI number — DR. STUART KEVIN BURGESS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
STUART
Provider Middle Name:
KEVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689676363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31796
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33631-3796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-318-7388
Provider Business Mailing Address Fax Number:
954-318-7350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 S. PINE ISLAND RD.
Provider Second Line Business Practice Location Address:
STE. A100
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-741-5555
Provider Business Practice Location Address Fax Number:
954-741-6298
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207WX0107X , with the licence number:  0072877 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650560968 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 226171 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 226171 . This is a "COMPBENEFITS CORPORATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2457349 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 41995 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 253381200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P180036348 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650560968 . This is a "UNITED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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