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General NPI Number Information
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NPI Number | 1740289453
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Entity Type | Individual
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Provider Name | JEFFERSON M BURROUGHS MD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 3000 MACK RD SUITE 100
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City | FAIRFIELD
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State | OH
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Zip | 45014-5335
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Country | US
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Telephone | 513-751-4222
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Fax | 513-751-4353
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Provider Business Mailing Address
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Address Line | 3000 MACK RD SUITE 100
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City | FAIRFIELD
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State | OH
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Zip | 45014-5335
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Country | US
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Telephone | 513-751-4222
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Fax | 513-751-4353
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35.060636
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 35.060636
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License Number State | OH
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