Healthcare Provider Details

I. General information

NPI: 1710130190
Provider Name (Legal Business Name): ETHAN DAVID BURDMAN PA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E GARFIELD AVE
GETTYSBURG SD
57442-1325
US

IV. Provider business mailing address

1515 VILLAGE DR
COTTAGE GROVE OR
97424-9700
US

V. Phone/Fax

Practice location:
  • Phone: 605-765-2273
  • Fax: 605-765-3212
Mailing address:
  • Phone: 541-767-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0692
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA164996
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: