Individual
RANDALL BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1007 SCOTT AVE, SUITE B, BREMERTON, WA 98310-4874
(360) 405-0293
Mailing address
1007 SCOTT AVE, SUITE B, BREMERTON, WA 98310-4874
(360) 405-0293
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60373034
WA
Other
Enumeration date
12/31/2013
Last updated
12/31/2013
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