Healthcare Provider Details

I. General information

NPI: 1972620672
Provider Name (Legal Business Name): COLE BURGMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 WORTH ST STE 725
DALLAS TX
75246-2089
US

IV. Provider business mailing address

5507 100TH ST
LUBBOCK TX
79424-6267
US

V. Phone/Fax

Practice location:
  • Phone: 214-824-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: