Healthcare Provider Details

I. General information

NPI: 1164124699
Provider Name (Legal Business Name): REX BURCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE FL 32073
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

3230 S RIDGEWOOD AVE
SOUTH DAYTONA FL
32119-3509
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-8500
  • Fax:
Mailing address:
  • Phone: 678-634-2318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: