Provider Demographics
NPI:1154767655
Name:BURGOS, PETER ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ARTHUR
Last Name:BURGOS
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 1:11701 S 101ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2230
Mailing Address - Country:US
Mailing Address - Phone:918-417-0074
Mailing Address - Fax:
Practice Address - Street 1:1337 S FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7205
Practice Address - Country:US
Practice Address - Phone:913-397-7800
Practice Address - Fax:913-397-7801
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24246207Q00000X
OK04-21442207Q00000X
IN01066005A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine