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NPI Code Detail

MEDICARE: DR. BURCHAM COOPER FUQUA JR. MD

MEDICARE:  DR. BURCHAM COOPER FUQUA JR. MD
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
1207R00000XInternal Medicine PhysicianF9456TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2TXB149313OTHERTXWELLMED PTAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396727392
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BURCHAM COOPER FUQUA JR. MD
Provider Business Mailing Address
First Line : 3434 SARATOGA BLVD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5822
Country : US
Telephone Number : 361-985-9355
Fax Number : 361-992-3458
Provider Business Practice Location Address
First Line : 3434 SARATOGA BLVD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78415-5822
Country : US
Telephone Number : 361-985-9355
Fax Number : 361-992-3458
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 07/14/2016

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Directions to “ DR. BURCHAM COOPER FUQUA JR. MD” Practice Location

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