MEDICARE: MR. THEODORE J BURDUMY 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
1	207L00000X	Anesthesiology Physician	G42096	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	:	1679569891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE J BURDUMY MD

Provider Business Mailing Address
First Line	:	237 TOWN CTR W
Second Line	:	SUITE 251
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-5075
Country	:	US
Telephone Number	:	805-598-9907
Fax Number	:	805-481-6192

Provider Business Practice Location Address
First Line	:	1400E CHURCH STREET
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5906
Country	:	US
Telephone Number	:	805-739-3100
Fax Number	:	805-739-3060

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	02/06/2014

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