Individual
REBECCA M. BURGOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5700 MONROE ST UNIT 103, SYLVANIA, OH 43560-2771
(419) 843-7996
(419) 841-7704
Mailing address
1 SEAGATE STE 800, TOLEDO, OH 43604-1558
(419) 843-7996
(419) 841-7704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003035
OH
363A00000X
Physician Assistant
5601007063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0103145
—
OH
Enumeration date
04/15/2010
Last updated
11/03/2023
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