Provider Demographics
NPI:1033401559
Name:BURCH, PAUL L (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:BURCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1218
Mailing Address - Country:US
Mailing Address - Phone:903-315-5750
Mailing Address - Fax:903-236-7145
Practice Address - Street 1:2131 S MOBBERLY AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-3563
Practice Address - Country:US
Practice Address - Phone:903-315-5750
Practice Address - Fax:903-236-7145
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant