Healthcare Provider Details

I. General information

NPI: 1265463525
Provider Name (Legal Business Name): YVETTE RR BURDICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVETTE RODRIGUEZ

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-7681
  • Fax:
Mailing address:
  • Phone: 970-874-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number172330
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number431108658
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0037783
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: