1649338815 NPI number — DANIEL BRADLEY BURDIN R.N., F.N.P.

Table of content: DANIEL BRADLEY BURDIN R.N., F.N.P. (NPI 1649338815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649338815 NPI number — DANIEL BRADLEY BURDIN R.N., F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURDIN
Provider First Name:
DANIEL
Provider Middle Name:
BRADLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N., F.N.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURDIN
Provider Other First Name:
DANIEL
Provider Other Middle Name:
BRAD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C., D.A.C.N.B.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649338815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9502 COMPUTER DR
Provider Second Line Business Mailing Address:
STE. 200A
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-2382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-690-6992
Provider Business Mailing Address Fax Number:
210-690-6952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9502 COMPUTER DR STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-2383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-690-6992
Provider Business Practice Location Address Fax Number:
210-690-6952
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  DC6933 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 781475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 644411ZGVZ . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8A7046 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".