Healthcare Provider Details

I. General information

NPI: 1508062407
Provider Name (Legal Business Name): DEAN CARSON BURDGE RPA,RA (CBRPA)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 METROPLEX DR SUITE 250
BIRMINGHAM AL
35209-6893
US

IV. Provider business mailing address

245 NEWCOMER TRL
FITZGERALD GA
31750-8651
US

V. Phone/Fax

Practice location:
  • Phone: 800-956-0179
  • Fax: 205-802-7549
Mailing address:
  • Phone: 229-426-7472
  • Fax: 229-424-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberJX28934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: