Provider Demographics
NPI:1316231517
Name:BURRUS, CLINT FIELD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:FIELD
Last Name:BURRUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5129
Mailing Address - Country:US
Mailing Address - Phone:830-401-7558
Mailing Address - Fax:830-401-7640
Practice Address - Street 1:1339 E COURT ST STE 240
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5141
Practice Address - Country:US
Practice Address - Phone:830-372-2791
Practice Address - Fax:830-386-0241
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TXQ3858207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349294401Medicaid