Basic Information
| Provider Information | |||||||||
| NPI: | 1063598373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURGESS | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157948900 | ||||||||
| FaxNumber: | 6157940038 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 SW 160TH AVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330276308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543994645 | ||||||||
| FaxNumber: | 8558552792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2006 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD0000025546 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2580466-009 | 01 | TN | CIGNA HEALTHCARE | OTHER | 1740257 | 01 | TN | UNITED HEALTHCARE | OTHER | 3083796 | 05 | TN | MEDICAID | 3021125 | 01 | TN | BCBS | OTHER | 681986 | 01 | TN | AETNA | OTHER |