Provider Demographics
NPI:1154053973
Name:BURUM, BENJAMIN FRANKLIN JR
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FRANKLIN
Last Name:BURUM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 CORPORATE DR STE 340-111
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4096
Mailing Address - Country:US
Mailing Address - Phone:832-563-8413
Mailing Address - Fax:
Practice Address - Street 1:10701 CORPORATE DR STE 340-111
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4096
Practice Address - Country:US
Practice Address - Phone:832-563-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator