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

Table of content: (NPI 1225890379)

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".