Provider Demographics
NPI:1508062407
Name:BURDGE, DEAN CARSON (RPA,RA (CBRPA))
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:CARSON
Last Name:BURDGE
Suffix:
Gender:M
Credentials:RPA,RA (CBRPA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 NEWCOMER TRL
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8651
Mailing Address - Country:US
Mailing Address - Phone:229-426-7472
Mailing Address - Fax:229-424-7283
Practice Address - Street 1:1 METROPLEX DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6893
Practice Address - Country:US
Practice Address - Phone:800-956-0179
Practice Address - Fax:205-802-7549
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJX28934243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant