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General NPI Number Information
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NPI Number | 1932756038
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Entity Type | Individual
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Provider Name | MYRON JON BURGER LSAA, LADAC
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Gender | Male
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 1501 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505-3521
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Country | US
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Telephone | 602-565-1656
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Fax | 505-212-0576
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Provider Business Mailing Address
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Address Line | 1501 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505-3521
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Country | US
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Telephone | 602-565-1656
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Fax | 505-212-0576
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAD0218661
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0151611
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License Number State | NM
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