MEDICARE: DR. EARL CREIGHTON BURGESS 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	2084P0800X	Psychiatry Physician	C23989	CA

General Provider Information

NPI Number	:	1528168226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EARL CREIGHTON BURGESS M.D.

Provider Business Mailing Address
First Line	:	333 MILLER AVE
Second Line	:	SUITE #2
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2846
Country	:	US
Telephone Number	:	415-225-0144
Fax Number	:	415-381-0524

Provider Business Practice Location Address
First Line	:	333 MILLER AVE
Second Line	:	SUITE #2
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2846
Country	:	US
Telephone Number	:	415-225-0144
Fax Number	:	415-381-0524

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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