Individual
MR. ETHAN DAVID BURDMAN
Active
Individual
MR. ETHAN DAVID BURDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA164996
OR
363AM0700X
Medical Physician Assistant
Primary
0692
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0692
SOUTH DAKOTA STATE LICENSE
SD
Enumeration date
10/29/2008
Last updated
09/10/2025
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