Healthcare Provider Details

I. General information

NPI: 1225622053
Provider Name (Legal Business Name): RICHARD LOUIS BURGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040A JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-0001
US

IV. Provider business mailing address

9005 S J ST
TACOMA WA
98444-4301
US

V. Phone/Fax

Practice location:
  • Phone: 125-396-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberDO.OP.61666129
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO.OP.61666129
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: