=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174919583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAXWELL ANDERSON BURCH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2015
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9617 GULF RESEARCH LN
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-418-0999
-----------------------------------------------------
Fax | 239-274-0773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9617 GULF RESEARCH LN
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-418-0999
-----------------------------------------------------
Fax | 239-418-0091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 145151
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------