Healthcare Provider Details

I. General information

NPI: 1972509032
Provider Name (Legal Business Name): NEIL A BURRELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 DELAWARE ST
BEAUMONT TX
77706-7602
US

IV. Provider business mailing address

6260 DELAWARE ST
BEAUMONT TX
77706-7602
US

V. Phone/Fax

Practice location:
  • Phone: 409-899-1538
  • Fax: 409-899-2120
Mailing address:
  • Phone: 409-899-1538
  • Fax: 409-899-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberTX1013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: