Provider Demographics
NPI:1417198557
Name:BURGESS, GEORGE EVANS III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EVANS
Last Name:BURGESS
Suffix:III
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 1:1156 STEELE BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6933
Mailing Address - Country:US
Mailing Address - Phone:225-346-1922
Mailing Address - Fax:225-346-1923
Practice Address - Street 1:1156 STEELE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6933
Practice Address - Country:US
Practice Address - Phone:225-346-1922
Practice Address - Fax:225-346-1923
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12566207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology