Healthcare Provider Details

I. General information

NPI: 1063556579
Provider Name (Legal Business Name): WILLIAM GRANT BURMER RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 DE CESARI AVE
MADERA CA
93637-3023
US

IV. Provider business mailing address

PO BOX 1082
MADERA CA
93639-1082
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-0146
  • Fax: 559-661-4801
Mailing address:
  • Phone: 559-675-0146
  • Fax: 559-661-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: