Basic Information
| Provider Information | |||||||||
| NPI: | 1548244692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MARSHALL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2484 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857186522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208882121 | ||||||||
| FaxNumber: | 5208884850 | ||||||||
| Practice Location | |||||||||
| Address1: | 2484 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857186522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208882121 | ||||||||
| FaxNumber: | 5208884850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 33153-020 | WI | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 44849 | AZ | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0101X | 44849 | AZ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0102X | 33153-020 | WI | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 44849 | 01 | AZ | STATE LICENSE | OTHER |