MEDICARE: CHARLES J BURCH 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	174400000X	Specialist	K2657	TX
2	207RP1001X	Pulmonary Disease Physician	K2657	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8A7078	OTHER	TX	MEDICARE LEGACY NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010KH	OTHER	TX	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831196559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES J BURCH MD

Provider Business Mailing Address
First Line	:	4458 MEDICAL DR
Second Line	:	STE 505
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3748
Country	:	US
Telephone Number	:	210-690-7400
Fax Number	:	210-957-6956

Provider Business Practice Location Address
First Line	:	21 SPURS LN
Second Line	:	SUITE 230B
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1669
Country	:	US
Telephone Number	:	210-690-7400
Fax Number	:	210-957-6956

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/31/2018

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Directions to “ CHARLES J BURCH MD” Practice Location

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