Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | Q0420 | TX |
N | 207VX0000X | Obstetrician | Q0420 | TX |
NPI | 1114243607 |
---|---|
Provider Name | Ms. Rebecca Lynn Burson |
First Address | Snyder, TX 79549-6162 |
Second Address | Snyder, TX 79549-6162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339363901 | (05) | TX |
8EL722 | BCBS (01) | TX |