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General NPI Number Information
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NPI Number | 1568444370
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Entity Type | Organization
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Legal Business Name | GAIL L BURLESON
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 6611 S RICE AVE
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City | BELLAIRE
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State | TX
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Zip | 77401-4012
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Country | US
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Telephone | 281-240-0448
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Fax | 713-668-2316
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Provider Business Mailing Address
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Address Line | 6611 S RICE AVE
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City | BELLAIRE
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State | TX
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Zip | 77401-4012
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Country | US
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Telephone | 281-240-0448
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Fax | 713-668-2316
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Authorized Official
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Title or Position | OWNER
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Name | MS. GAIL L BURLESON
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Credential | R.T.
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Telephone | 713-668-7481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | M00602
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License Number State | TX
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