Basic Information
| Provider Information | |||||||||
| NPI: | 1205120383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGE | ||||||||
| FirstName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 HOLCOMBE BLVD STE NB-34L | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770212039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328283660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7600 WOLF RIVER BLVD STE 220 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017555300 | ||||||||
| FaxNumber: | 9017539659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 28474 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 59188 | TN | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.