Provider Demographics
NPI:1528168226
Name:BURGESS, EARL CREIGHTON (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:CREIGHTON
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 MILLER AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2846
Mailing Address - Country:US
Mailing Address - Phone:415-225-0144
Mailing Address - Fax:415-381-0524
Practice Address - Street 1:333 MILLER AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2846
Practice Address - Country:US
Practice Address - Phone:415-225-0144
Practice Address - Fax:415-381-0524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC239892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry