MEDICARE: LESLIE R BURSON D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	20A5701	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194736983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE R BURSON D.O

Provider Business Mailing Address
First Line	:	15830 ARABELLA AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93314-7808
Country	:	US
Telephone Number	:	661-589-2171
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEMORIAL HOSPITAL EMERGENCY DEPARTMENT
Second Line	:	420 34TH STREET
City	:	BAKERSFIELD
State	:	CA
Zip	:	93303
Country	:	US
Telephone Number	:	661-327-9095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/04/2020

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