Provider Demographics
NPI:1093836819
Name:BURZYNSKI, STANISLAW R (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STANISLAW
Middle Name:R
Last Name:BURZYNSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9432 OLD KATY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6330
Mailing Address - Country:US
Mailing Address - Phone:713-335-5697
Mailing Address - Fax:713-335-5658
Practice Address - Street 1:9432 OLD KATY RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6330
Practice Address - Country:US
Practice Address - Phone:713-335-5697
Practice Address - Fax:713-335-5658
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9377261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21614Medicare UPIN