Provider Demographics
NPI:1366473092
Name:BURLESON, DALE D (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:BURLESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16980 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1974
Mailing Address - Country:US
Mailing Address - Phone:214-343-8565
Mailing Address - Fax:214-342-3054
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:SUITE 770
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:972-526-0910
Practice Address - Fax:972-526-0913
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9830208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120590805Medicaid
TX120590806Medicaid
TX120590805Medicaid
TX8625B7Medicare PIN