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General NPI Number Information
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NPI Number | 1457533473
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Entity Type | Individual
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Provider Name | ROXANNE L BURGESS DPM
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Gender | Female
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 11030 S TRYON ST STE 308
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City | CHARLOTTE
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State | NC
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Zip | 28273-6545
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Country | US
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Telephone | 704-504-1004
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Fax | 704-504-0007
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Provider Business Mailing Address
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Address Line | 11030 S TRYON ST STE 308
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City | CHARLOTTE
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State | NC
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Zip | 28273-6545
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Country | US
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Telephone | 704-504-1004
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Fax | 704-504-0007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | NC461
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | NC461
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License Number State | NC
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