Provider Demographics
NPI:1063648525
Name:BURST, DANIEL J (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:BURST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:722 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5516
Mailing Address - Country:US
Mailing Address - Phone:504-392-7123
Mailing Address - Fax:504-392-7823
Practice Address - Street 1:120 MEADOWCREST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5255
Practice Address - Country:US
Practice Address - Phone:504-392-7123
Practice Address - Fax:504-392-7823
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200267363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical