Healthcare Provider Details

I. General information

NPI: 1003098815
Provider Name (Legal Business Name): GRETCHEN M BURES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E BROAD ST
MANSFIELD TX
76063-5899
US

IV. Provider business mailing address

520 MADISON OAK DR
SAN ANTONIO TX
78258-3913
US

V. Phone/Fax

Practice location:
  • Phone: 682-242-2000
  • Fax:
Mailing address:
  • Phone: 210-297-6500
  • Fax: 210-297-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN6198
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: