| Doctor Name: | JERRY B BURGESS |
| NPI Number: | 1083890370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 50852-020 |
| Business Practice Address: | 210 W Capitol Dr Milwaukee, WI - 532121123 |
| Business Phone Number: | 3134025995 |
| Business Fax Number: | |
| Mailing Address: | 300 E Oakland Park Blvd # 194, OAKLAND PARK |
| State: | FL |
| Postal Code: | 333342148 |
| Phone Number: | 3134025995 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2008 |
| NPI Last Update Date: | 12/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 50852-020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |