Individual
JASON M BURGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 UNITY PL, SUITE 245, LAFAYETTE, IN 47905-5770
(765) 446-5130
(765) 446-5131
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01046886A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180043005
RAILROAD MEDICARE
IN
05
—
200133220
—
IN
Enumeration date
05/17/2006
Last updated
06/15/2020
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