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Individual
KRISTIAN DEREK BURGESS
Active
Individual
KRISTIAN DEREK BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2931
NV
207Q00000X
Family Medicine Physician
OT018627
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457844292
—
NV
01
—
DO2931
STATE LICENSE
NV
05
—
OT018627
—
PA
Enumeration date
06/06/2018
Last updated
10/17/2022
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