Individual
KRISTIAN DEREK BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
786 W PIONEER BLVD STE A, MESQUITE, NV 89027-8862
(702) 345-5000
(702) 345-2000
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO2931
NV
207Q00000X
Family Medicine Physician
OT018627
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457844292
—
NV
01
—
DO2931
STATE LICENSE
NV
05
—
OT018627
—
PA
Enumeration date
06/06/2018
Last updated
10/17/2022
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