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General NPI Number Information
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NPI Number | 1033401559
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Entity Type | Individual
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Provider Name | PAUL L. BURCH PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 2131 S MOBBERLY AVE
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City | LONGVIEW
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State | TX
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Zip | 75602-3563
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Country | US
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Telephone | 903-315-5750
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Fax | 903-236-7145
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Provider Business Mailing Address
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Address Line | PO BOX 731218
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City | DALLAS
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State | TX
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Zip | 75373-1218
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Country | US
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Telephone | 903-315-5750
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Fax | 903-236-7145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07292
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License Number State | TX
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