Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301072043 | MI |
N | 111NI0900X | Internist | 4301072043 | MI |
Y | 207RG0100X | Gastroenterologist | 4301072043 | MI |
NPI | 1033291554 |
---|---|
Provider Name | Ezra Burstein |
First Address | Dallas, TX 75235-6234 |
Second Address | Dallas, TX 75235-6234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 14/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4398584 | (05) | MI |
H60143 | (02) | MI |