Provider Demographics
NPI:1043324569
Name:BURGAN, RICHARD S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:S
Last Name:BURGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 PLEASANT VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-9774
Mailing Address - Country:US
Mailing Address - Phone:270-417-7500
Mailing Address - Fax:270-417-7509
Practice Address - Street 1:1301 PLEASANT VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-9774
Practice Address - Country:US
Practice Address - Phone:270-417-7500
Practice Address - Fax:270-417-7509
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500351300Medicaid
S98277Medicare UPIN
KY0320415Medicare PIN
KYK001981Medicare PIN
KY9500351300Medicaid