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General NPI Number Information
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NPI Number | 1528160371
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Entity Type | Individual
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Provider Name | DAVID E BURSTEDT MD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 105 S WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-4667
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Country | US
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Telephone | 931-372-7716
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Fax | 931-372-0087
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Provider Business Mailing Address
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Address Line | 105 S WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-4667
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Country | US
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Telephone | 931-372-7716
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Fax | 931-372-7717
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | BP10053739
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 11069136-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | RPT-1815
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 61181
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License Number State | TN
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