Provider Demographics
NPI:1467531632
Name:BURGOS, AGUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
Last Name:BURGOS
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 1:1113 WATERSIDE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2030
Mailing Address - Country:US
Mailing Address - Phone:954-474-1113
Mailing Address - Fax:954-382-4910
Practice Address - Street 1:1367 S UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4000
Practice Address - Country:US
Practice Address - Phone:954-474-1113
Practice Address - Fax:954-382-4910
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274451OtherAUMED
FL47137OtherBLUE CROSS
FL47137OtherBLUE CROSS
G50505Medicare UPIN