Provider Demographics
NPI:1689676363
Name:BURGESS, STUART KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:KEVIN
Last Name:BURGESS
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:PO BOX 31796
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3796
Mailing Address - Country:US
Mailing Address - Phone:954-318-7388
Mailing Address - Fax:954-318-7350
Practice Address - Street 1:850 S. PINE ISLAND RD.
Practice Address - Street 2:STE. A100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-741-5555
Practice Address - Fax:954-741-6298
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0072877207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650560968OtherCIGNA
FL226171OtherAVMED
FL226171OtherCOMPBENEFITS CORPORATION
FL2457349OtherAETNA
FL41995OtherBLUE CROSS BLUE SHEILD
FL253381200Medicaid
FLP180036348OtherRAILROAD MEDICARE
FL650560968OtherUNITED
FL41995ZMedicare PIN
FL226171OtherAVMED
FL253381200Medicaid