Provider Demographics
NPI:1477669810
Name:BURGE, DONALD EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EUGENE
Last Name:BURGE
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 1:5200 S 56TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1884
Mailing Address - Country:US
Mailing Address - Phone:402-421-8900
Mailing Address - Fax:402-421-6070
Practice Address - Street 1:5200 S 56TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1884
Practice Address - Country:US
Practice Address - Phone:402-421-8900
Practice Address - Fax:402-421-6070
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084393900Medicaid
A80642Medicare UPIN
NE47084393900Medicaid