Healthcare Provider Details

I. General information

NPI: 1750463048
Provider Name (Legal Business Name): ERNEST G BURCH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD SUITE B217
MOBILE AL
36608-6705
US

IV. Provider business mailing address

6701 AIRPORT BLVD SUITE B217
MOBILE AL
36608-6705
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-8881
  • Fax: 251-633-0467
Mailing address:
  • Phone: 251-633-8881
  • Fax: 251-633-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23467
License Number StateAL

VIII. Authorized Official

Name: ERNEST G BURCH
Title or Position: PRES
Credential: MD
Phone: 251-633-8881