Individual
WILLIAM R BURGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3269 STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 753-7776
Mailing address
PO BOX 73878, SAN CLEMENTE, CA 92673-0130
(714) 754-5800
(714) 754-6800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
32154
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
32154
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842494
—
AZ
Enumeration date
03/08/2007
Last updated
01/02/2019
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