Provider Demographics
NPI:1235544578
Name:BURGE, JOHN ROSS (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROSS
Last Name:BURGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N BRENT ST STE 505
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2840
Mailing Address - Country:US
Mailing Address - Phone:805-648-3902
Mailing Address - Fax:805-648-4014
Practice Address - Street 1:168 N BRENT ST STE 505
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-648-3902
Practice Address - Fax:805-648-4014
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14460207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery