Healthcare Provider Details

I. General information

NPI: 1689693392
Provider Name (Legal Business Name): STEVEN T BURDINE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CAHILL RD STE 206
BRANSON MO
65616-1911
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8100
  • Fax: 417-348-8104
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2013041192
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: