Provider Demographics
NPI:1710130190
Name:BURDMAN, ETHAN DAVID (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:DAVID
Last Name:BURDMAN
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9700
Mailing Address - Country:US
Mailing Address - Phone:541-767-5222
Mailing Address - Fax:
Practice Address - Street 1:608 E GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1325
Practice Address - Country:US
Practice Address - Phone:605-765-2273
Practice Address - Fax:605-765-3212
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0692363AM0700X
ORPA164996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0692OtherSOUTH DAKOTA STATE LICENSE