Individual
CANTON BURLESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5736 E RED OAK DR APT 10, SIOUX FALLS, SD 57110-4029
(509) 778-2291
Mailing address
5736 E RED OAK DR APT 10, SIOUX FALLS, SD 57110-4029
(509) 778-2291
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
8522-4548-2179
SD
Other
Enumeration date
04/11/2025
Last updated
04/11/2025
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