Basic Information
| Provider Information | |||||||||
| NPI: | 1356507347 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMBURGER | ||||||||
| FirstName: | EARL | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770983106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135126000 | ||||||||
| FaxNumber: | 7135126021 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770983106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135126000 | ||||||||
| FaxNumber: | 7135126021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2008 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 029236 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 0028110-01 | 01 | TX | TEXAS PROVIDER IDENTIFIER | OTHER |