Provider Demographics
NPI:1134307788
Name:BURLESON, GAIL L (RT(N))
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:BURLESON
Suffix:
Gender:F
Credentials:RT(N)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 S RICE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4012
Mailing Address - Country:US
Mailing Address - Phone:713-668-7481
Mailing Address - Fax:713-668-2316
Practice Address - Street 1:6611 S RICE AVE
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4012
Practice Address - Country:US
Practice Address - Phone:713-668-7481
Practice Address - Fax:713-668-2316
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM006022471M2300X
TXR236572471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N30NMedicare UPIN