MEDICARE: DR. JOHN B BURGESS JR. M.D.

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	207P00000X	Emergency Medicine Physician	MD.207514	LA
2	2083X0100X	Occupational Medicine Physician	MD.207514	LA

General Provider Information

NPI Number	:	1326024613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B BURGESS JR. M.D.

Provider Business Mailing Address
First Line	:	4045 SCENIC HWY
Second Line	:	EMPR 126
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4860
Country	:	US
Telephone Number	:	225-977-8571
Fax Number	:	225-977-8307

Provider Business Practice Location Address
First Line	:	4045 SCENIC HWY
Second Line	:	EMPR 126
City	:	BATON ROUGE
State	:	LA
Zip	:	70805-4860
Country	:	US
Telephone Number	:	225-977-8571
Fax Number	:	225-977-8307

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	02/26/2016

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