Provider Demographics
NPI:1528435807
Name:BURG FOOT & ANKLE PA
Entity type:Organization
Organization Name:BURG FOOT & ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:BURG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-689-3843
Mailing Address - Street 1:12681 NEW BRITTANY BLVD
Mailing Address - Street 2:BLDG 1E
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3631
Mailing Address - Country:US
Mailing Address - Phone:239-689-3843
Mailing Address - Fax:239-689-3852
Practice Address - Street 1:12681 NEW BRITTANY BLVD
Practice Address - Street 2:BLDG 1E
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3631
Practice Address - Country:US
Practice Address - Phone:239-689-3843
Practice Address - Fax:239-689-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2882213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty