Provider Demographics
NPI:1437109394
Name:BURSON, ANNA CHRISTELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:CHRISTELLA
Last Name:BURSON
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 1:720 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4343
Mailing Address - Country:US
Mailing Address - Phone:580-226-9994
Mailing Address - Fax:580-226-9998
Practice Address - Street 1:720 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4343
Practice Address - Country:US
Practice Address - Phone:580-226-9994
Practice Address - Fax:580-226-9998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5471OtherTEXAS PERMIT
OKH00867Medicare UPIN