Provider Demographics
NPI:1831156157
Name:BURGESS, RONALD C (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:C
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 1:1780 NICHOLASVILLE RD
Mailing Address - Street 2:STE 601
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1400
Mailing Address - Country:US
Mailing Address - Phone:859-253-0124
Mailing Address - Fax:859-231-8667
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 601
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-253-0124
Practice Address - Fax:859-231-8667
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23507207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64235070Medicaid
KY64235070Medicaid
KY0028206Medicare PIN