Basic Information
| Provider Information | |||||||||
| NPI: | 1356383467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURR | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 RIDGEVIEW ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787042043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124474909 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12221 N. MOPAC EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129011000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 05/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | H1475 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | H1475 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 136601506 | 05 | TX | MEDICAID | 136601510 | 05 | TX | MEDICAID |