Provider Demographics
NPI:1972638294
Name:BURGESS, ANDREA LIZETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LIZETTE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EXEMPLA CIRCLE
Mailing Address - Street 2:SUITE 470
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3396
Mailing Address - Country:US
Mailing Address - Phone:303-665-6016
Mailing Address - Fax:303-665-0121
Practice Address - Street 1:300 EXEMPLA CIRCLE
Practice Address - Street 2:SUITE 470
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3396
Practice Address - Country:US
Practice Address - Phone:303-665-6016
Practice Address - Fax:303-665-0121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19448207V00000X
CO49111207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology