Healthcare Provider Details

I. General information

NPI: 1356321517
Provider Name (Legal Business Name): FRED EARL BURSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 FRANKLIN AVE
LEMOORE CA
93246-0001
US

IV. Provider business mailing address

2213 WINCHESTER ST
OCEANSIDE CA
92054-3545
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4262
  • Fax:
Mailing address:
  • Phone: 760-721-2813
  • Fax: 760-754-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A3239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: