Individual
JERALD MILLER BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19 MEDICAL LOOP, SUITE #3, WHITLEY CITY, KY 42653-4382
(606) 376-5391
(606) 376-3326
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 864-1472
(270) 864-1693
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17906
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64179062
—
KY
Enumeration date
01/02/2007
Last updated
04/22/2015
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