1679774160 NPI number — DR. RICHARD BURG M.D.

Table of content: DR. RICHARD BURG M.D. (NPI 1679774160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679774160 NPI number — DR. RICHARD BURG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURG
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679774160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 RAINTREE CIR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-727-9995
Provider Business Mailing Address Fax Number:
972-727-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 RAINTREE CIR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-727-9995
Provider Business Practice Location Address Fax Number:
972-727-8350
Provider Enumeration Date:
05/30/2007

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: 207X00000X , with the licence number:  M9890 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: M9890 , 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: 202607201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TXB117538 . This is a "MEDICARE PART B - EFFECT. 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8CR165 . This is a "BC/BS TX - EFFECT. 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00913318 . This is a "MEDICARE RAILROAD - EFFECT 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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