Healthcare Provider Details

I. General information

NPI: 1346737046
Provider Name (Legal Business Name): MARY F BURGESSER MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W EXCHANGE PKWY STE 120
ALLEN TX
75013-4696
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 972-521-6210
  • Fax:
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberK4005
License Number StateTX

VIII. Authorized Official

Name: MR. JEFF BARBER
Title or Position: MGR
Credential:
Phone: 806-355-6593