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General NPI Number Information
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NPI Number | 1841265618
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Entity Type | Individual
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Provider Name | MICHAEL LOUIS BURLESON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 14529 MARSH VIEW DR
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City | JACKSONVILLE
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State | FL
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Zip | 32250-2058
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Country | US
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Telephone | 305-304-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 14529 MARSH VIEW DR
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City | JACKSONVILLE
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State | FL
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Zip | 32250-2058
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Country | US
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Telephone | 305-304-5727
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G75674
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME 102060
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License Number State | FL
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