MEDICARE: DR. HOLLIS A. BURGGRAF MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	42895	CO
2	207Q00000X	Family Medicine Physician	9939A	WY
3	207Q00000X	Family Medicine Physician	2014040818	MO
4	207Q00000X	Family Medicine Physician	15656	NV
5	207Q00000X	Family Medicine Physician	107-320	WI
6	207Q00000X	Family Medicine Physician	MED-PHYS-LIC-35639	MT
7	207Q00000X	Family Medicine Physician	MD2014-0872	NM
8	207Q00000X	Family Medicine Physician	M-12722	ID
9	207Q00000X	Family Medicine Physician	63507	MN
10	207Q00000X	Family Medicine Physician	MD-17921	HI
11	207Q00000X	Family Medicine Physician	036145467	IL
12	207Q00000X	Family Medicine Physician	MD60510290	WA
13	207Q00000X	Family Medicine Physician	A68380	CA
14	207Q00000X	Family Medicine Physician	MD170137	OR
15	207Q00000X	Family Medicine Physician	25625	AZ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00423070	OTHER	CO	MEDICARE RAILROAD CARRIER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25625	OTHER	AZ	AZ LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	840255530056	OTHER	CO	ROCKY MTN HEALTH PLANS

NPI Number	:	1962484329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLIS A. BURGGRAF MD

Provider Business Mailing Address
First Line	:	1 CALIFORNIA ST STE 2300
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-5424
Country	:	US
Telephone Number	:	800-997-6196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CALIFORNIA ST STE 2300
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-5424
Country	:	US
Telephone Number	:	800-997-6196
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/30/2025

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515