Healthcare Provider Details

I. General information

NPI: 1477518926
Provider Name (Legal Business Name): ERNEST GEORGE BURCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE A208
MOBILE AL
36608-3763
US

IV. Provider business mailing address

6701 AIRPORT BLVD STE D143
MOBILE AL
36608-6701
US

V. Phone/Fax

Practice location:
  • Phone: 251-266-3544
  • Fax: 251-266-3543
Mailing address:
  • Phone: 251-342-3949
  • Fax: 251-631-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00023467
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.23467
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: