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General NPI Number Information
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NPI Number | 1861474058
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Entity Type | Individual
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Provider Name | KENT REYNOLDS BURRESS DPM
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1819 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714
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Country | US
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Telephone | 812-457-7020
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Fax | 812-477-0200
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Provider Business Mailing Address
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Address Line | 1819 WASHINGTON AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714
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Country | US
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Telephone | 812-477-0200
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Fax | 812-477-1267
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0700515
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License Number State | IN
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