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General NPI Number Information
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NPI Number | 1710020151
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Entity Type | Individual
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Provider Name | BOB BURLISON P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 1590 W LIBERTY RD
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City | ATOKA
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State | OK
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Zip | 74525-1701
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Country | US
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Telephone | 580-889-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 804 W ENID AVE
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City | WILBURTON
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State | OK
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Zip | 74578-2248
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Country | US
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Telephone | 580-239-0449
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA642
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License Number State | OK
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