Provider Demographics
NPI:1376501221
Name:BURGAN, BRIAN KEITH (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:BURGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7694 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3162
Mailing Address - Country:US
Mailing Address - Phone:423-206-9742
Mailing Address - Fax:423-206-7943
Practice Address - Street 1:7694 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3162
Practice Address - Country:US
Practice Address - Phone:423-206-9742
Practice Address - Fax:423-206-9743
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000785213E00000X
TNDPM0000000489213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011198Medicaid
GA485CCPGMedicare ID - Type Unspecified
TN3352580Medicare ID - Type Unspecified
TN3352580Medicaid