Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | P3863 | TX |
NPI | 1114277639 |
---|---|
Provider Name | Sudeep Dustin Burman |
First Address | Austin, TX 78745-1189 |
Second Address | Austin, TX 78745-1189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 11/09/2019 |