Individual
JEFFERSON M BURROUGHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3000 MACK RD, SUITE 100, FAIRFIELD, OH 45014-5335
(513) 751-4222
(513) 751-4353
Mailing address
3000 MACK RD, SUITE 100, FAIRFIELD, OH 45014-5335
(513) 751-4222
(513) 751-4353
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35.060636
OH
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
35.060636
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0773102
—
KY
05
—
0807587
—
OH
05
—
100383700
—
IN
Enumeration date
07/15/2005
Last updated
11/12/2015
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