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General NPI Number Information
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NPI Number | 1710130190
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Entity Type | Individual
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Provider Name | ETHAN DAVID BURDMAN PA-C, MPAS
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Gender | Male
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 608 E GARFIELD AVE
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City | GETTYSBURG
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State | SD
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Zip | 57442-1325
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Country | US
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Telephone | 605-765-2273
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Fax | 605-765-3212
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Provider Business Mailing Address
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Address Line | 1515 VILLAGE DR
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-9700
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Country | US
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Telephone | 541-767-5222
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0692
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA164996
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License Number State | OR
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