Provider Demographics
NPI:1003817768
Name:BURBRIDGE, GAIL E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:E
Last Name:BURBRIDGE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 1362
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-523-2411
Mailing Address - Fax:713-796-8952
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 1362
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-523-2411
Practice Address - Fax:713-796-8952
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:2005-08-03
Deactivation Code:
Reactivation Date:2006-05-01
Provider Licenses
StateLicense IDTaxonomies
TXE2152208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0238Medicare ID - Type UnspecifiedMEDICARE
TXB21584Medicare UPIN