Provider Demographics
NPI:1083838809
Name:BURGESS, CHRISTINE RENEE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3445 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:STE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1678
Mailing Address - Country:US
Mailing Address - Phone:512-579-4000
Mailing Address - Fax:512-439-2814
Practice Address - Street 1:3445 EXECUTIVE CENTER DRIVE
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1678
Practice Address - Country:US
Practice Address - Phone:512-579-4000
Practice Address - Fax:512-439-2814
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054758207ZP0105X
TXM7343207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AN450OtherBCBSTX
TX189996502OtherCSHCN
TX189996501Medicaid
TX189996503Medicaid
TX189996501Medicaid
TX8J7837Medicare PIN
TX8AN450OtherBCBSTX