MEDICARE: STEVEN D BURDETT

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	174400000X	Specialist	531	NM
2	235Z00000X	Speech-Language Pathologist	3285	NM

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	:	1619430493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN D BURDETT

Provider Business Mailing Address
First Line	:	23510 ENCHANTED VW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4318
Country	:	US
Telephone Number	:	505-559-0164
Fax Number	:	505-212-1141

Provider Business Practice Location Address
First Line	:	13 DOS LOCOS
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-5014
Country	:	US
Telephone Number	:	505-559-0164
Fax Number	:	505-212-1141

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

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	04/09/2019

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Directions to “ STEVEN D BURDETT ” Practice Location

Language	Start Address	Practice Location

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