Individual
GARY R. BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4621 EMERSON ST, JACKSONVILLE, FL 32207-4920
(904) 399-8884
Mailing address
1895 SENTRY OAK CT, GREEN COVE SPRINGS, FL 32043-3775
(904) 284-4190
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103396
FL
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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