Provider Demographics
NPI:1609831841
Name:BURPEE, STEPHEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:BURPEE
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 1:6130 N LA CHOLLA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3698
Mailing Address - Country:US
Mailing Address - Phone:520-219-8690
Mailing Address - Fax:520-219-8694
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3698
Practice Address - Country:US
Practice Address - Phone:520-219-8690
Practice Address - Fax:520-219-8694
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31226174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ759425Medicaid
AZZ155752Medicare PIN
AZ759425Medicaid