Healthcare Provider Details

I. General information

NPI: 1336161702
Provider Name (Legal Business Name): RICHARD CHIPMAN BURGESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MAIN ST SUITE 201
LEWISVILLE TX
75057-3629
US

IV. Provider business mailing address

8267 ELMBROOK DR SUITE 100
DALLAS TX
75247-4030
US

V. Phone/Fax

Practice location:
  • Phone: 972-434-1052
  • Fax: 972-420-8542
Mailing address:
  • Phone: 214-237-1664
  • Fax: 214-237-1864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE4233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: