MEDICARE: DANIEL BRADLEY BURDIN R.N., F.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	DC6933	TX
2	363LF0000X	Family Nurse Practitioner	781475	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	644411ZGVZ	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8A7046	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649338815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BRADLEY BURDIN R.N., F.N.P.

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

Provider Business Practice Location Address
First Line	:	9502 COMPUTER DR STE 200A
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2383
Country	:	US
Telephone Number	:	210-690-6992
Fax Number	:	210-690-6952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	04/24/2018

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