Healthcare Provider Details

I. General information

NPI: 1528435807
Provider Name (Legal Business Name): BURG FOOT & ANKLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12681 NEW BRITTANY BLVD BLDG 1E
FORT MYERS FL
33907-3631
US

IV. Provider business mailing address

12681 NEW BRITTANY BLVD BLDG 1E
FORT MYERS FL
33907-3631
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-3843
  • Fax: 239-689-3852
Mailing address:
  • Phone: 239-689-3843
  • Fax: 239-689-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2882
License Number StateFL

VIII. Authorized Official

Name: DR. BRIAN DENNIS BURG
Title or Position: OWNER
Credential: DPM
Phone: 239-689-3843