MEDICARE: DR. WILLIAM WALTER BURGIN JR. M.D.

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	207RP1001X	Pulmonary Disease Physician	E1998	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110031826	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	E1998	OTHER	TX	STATE LICENSE
4	00P934	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1760411243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM WALTER BURGIN JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60107
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78466-0107
Country	:	US
Telephone Number	:	361-884-8200
Fax Number	:	361-882-6649

Provider Business Practice Location Address
First Line	:	1702 HORNE RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1902
Country	:	US
Telephone Number	:	361-884-8200
Fax Number	:	361-882-6649

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	05/01/2013

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