Provider Demographics
NPI:1396207361
Name:BURCH, ALEXANDER STEVEN
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:STEVEN
Last Name:BURCH
Suffix:
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 1:312 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1943
Mailing Address - Country:US
Mailing Address - Phone:504-554-1349
Mailing Address - Fax:
Practice Address - Street 1:121 N 20TH ST STE 6
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5454
Practice Address - Country:US
Practice Address - Phone:334-749-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN149926163W00000X
AL1-161504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse