=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376501221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN KEITH BURGAN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2006
-----------------------------------------------------
Last Update Date | 04/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7694 E BRAINERD RD
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-3162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-206-9742
-----------------------------------------------------
Fax | 423-206-9743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7694 E BRAINERD RD
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-3162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-206-9742
-----------------------------------------------------
Fax | 423-206-7943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | POD000785
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | DPM0000000489
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------