Provider Demographics
NPI:1477510543
Name:BURGER, HARRY RUSSELL (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:RUSSELL
Last Name:BURGER
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 1:12127B HWY 14 N
Mailing Address - Street 2:STE 5
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9461
Mailing Address - Country:US
Mailing Address - Phone:505-281-2460
Mailing Address - Fax:505-281-2463
Practice Address - Street 1:12127 B HWY 14 N
Practice Address - Street 2:STE 5
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9461
Practice Address - Country:US
Practice Address - Phone:505-281-2460
Practice Address - Fax:505-281-2463
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA1224032083X0100X, 208600000X
NMA-1224-03208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01324331Medicaid
NM01786342Medicaid
NM46650024Medicaid
NM53938577Medicaid
NM51305879Medicaid
NM1324331Medicaid
NM28777841Medicaid
NM01786342Medicaid
NM51305879Medicaid
NM1324331Medicaid
NM1324331Medicaid