MEDICARE: ROBERT BURGESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	4820	SD

General Provider Information

NPI Number	:	1013961978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BURGESS

Provider Business Mailing Address
First Line	:	2820 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-5462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E MINNESOTA ST
Second Line	:	SUITE 210
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7756
Country	:	US
Telephone Number	:	605-342-3280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/18/2012

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Directions to “ ROBERT BURGESS ” Practice Location

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