Most Relevant Information
Provider Data
| NPI Number: | 1003288754 |
| Provider Name: | RICHARD BURGESS |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9109174 |
Most Important Dates
| Enumeration Date: | 10/21/2015 |
| Last Updated: | 10/29/2021 |
Provider Practice Location
3840 COLONIAL BLVD STE 1
FORT MYERS
FL
339661126
Practice Location Phone/Fax
| Phone: | 8557786262 |
| Fax: | 8557783262 |
Provider Mailing Location
3840 COLONIAL BLVD STE 1
FORT MYERS
FL
339661126
Provider Mailing Phone/Fax
| Phone: | 8557786262 |
| Fax: | 8557783262 |