Healthcare Provider Details

I. General information

NPI: 1316449978
Provider Name (Legal Business Name): CLIFFORD PAUL BURDICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 LINTON BLVD
DELRAY BEACH FL
33484-6543
US

IV. Provider business mailing address

4050 NE 12TH TER APT 31
OAKLAND PARK FL
33334-4601
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-1754
  • Fax:
Mailing address:
  • Phone: 401-248-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9327466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: