Individual
MR. SCOTT DANIEL BURGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1108 E HISTORIC HIGHWAY 66, GALLUP, NM 87301-5466
(505) 726-9642
(505) 726-9642
Mailing address
1108 E HISTORIC HIGHWAY 66, GALLUP, NM 87301-5466
(505) 726-9642
(505) 726-9642
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
CHW0000000656
AZ
172V00000X
Community Health Worker
Primary
G-1774
NM
247ZC0005X
Clinical Laboratory Director (Non-physician)
32D2133123
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073138244
GROUP NPI
—
05
—
N0035451
—
NM
Enumeration date
04/01/2024
Last updated
10/14/2025
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