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General NPI Number Information
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NPI Number | 1689147282
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Entity Type | Individual
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Provider Name | CHRISTOPHER JORDAN BURFORD CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 1541 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-655-0835
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Fax |
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Provider Business Mailing Address
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Address Line | 5075 DIXIE GARDEN DR
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City | SHREVEPORT
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State | LA
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Zip | 71105-4027
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Country | US
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Telephone | 318-655-0835
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN083054
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 202458
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License Number State | LA
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