Healthcare Provider Details

I. General information

NPI: 1700851557
Provider Name (Legal Business Name): GARY ROBERT BURMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15035 EAST FWY SUITE D
CHANNELVIEW TX
77530-4135
US

IV. Provider business mailing address

15035 EAST FWY SUITE D
CHANNELVIEW TX
77530-4135
US

V. Phone/Fax

Practice location:
  • Phone: 281-457-0477
  • Fax: 281-457-6238
Mailing address:
  • Phone: 281-457-0477
  • Fax: 281-457-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ1204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: