Provider Demographics
NPI:1881680221
Name:BURGESS, JOHN F (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BURGESS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WESTFIELD AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1834
Mailing Address - Country:US
Mailing Address - Phone:775-323-2544
Mailing Address - Fax:775-323-5923
Practice Address - Street 1:1225 WESTFIELD AVE
Practice Address - Street 2:STE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1834
Practice Address - Country:US
Practice Address - Phone:775-323-2544
Practice Address - Fax:775-323-5923
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV33213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2116834Medicaid
T67155Medicare UPIN
V$$$$$$$$$Medicare PIN
NV0745780001Medicare NSC