Provider Demographics
NPI:1285667204
Name:BURGOS FUSTER, LUZ MINERVA (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MINERVA
Last Name:BURGOS FUSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OFFICE PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2437
Mailing Address - Country:US
Mailing Address - Phone:205-803-4330
Mailing Address - Fax:205-803-4354
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 628
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-870-4783
Practice Address - Fax:205-879-7043
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27293207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI58164Medicare UPIN