Provider Demographics
NPI:1639134430
Name:BURLESON, JAMES RAY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RAY
Last Name:BURLESON
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 1:1700 COGDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6162
Mailing Address - Country:US
Mailing Address - Phone:325-574-7437
Mailing Address - Fax:325-574-7433
Practice Address - Street 1:1700 COGDELL BLVD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549
Practice Address - Country:US
Practice Address - Phone:325-573-1300
Practice Address - Fax:325-574-6984
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8367207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133371808Medicaid
TX81W463OtherBCBS OF TX
TX133371802Medicaid
TX133371802Medicaid
TX81W463Medicare PIN
TX81W463Medicare PIN