Individual
STEPHEN SPENCER BURNSIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 E REZANOF DR, KODIAK, AK 99615
(907) 486-6065
(907) 486-2248
Mailing address
1818 E REZANOF DR, KODIAK, AK 99615
(907) 486-6065
(907) 486-2248
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
AA2876
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920088665
EMPLOYEE ID
AK
05
—
GR0173
—
AK
05
—
MD 03803
—
AK
Enumeration date
02/27/2006
Last updated
04/15/2013
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