Provider Demographics
NPI:1235118589
Name:BURGESS, JAMES B (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S DOBSON RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5602
Mailing Address - Country:US
Mailing Address - Phone:480-393-0575
Mailing Address - Fax:480-704-4019
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-393-0575
Practice Address - Fax:480-704-4019
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ19514207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298184Medicaid
AZZ152208Medicare PIN
AZ298184Medicaid