Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G9333 | TX |
Y | 2082S0105X | Plastic Hand Surgeon | G9333 | TX |
NPI | 1750471983 |
---|---|
Provider Name | Dr. Brian Fred Burns |
First Address | Victoria, TX 77901-6040 |
Second Address | Victoria, TX 77901-6040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122349701 | (05) | TX |
E47383 | (02) | TX |