Provider Demographics
NPI:1679774160
Name:BURG, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BURG
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 1:1125 RAINTREE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4900
Mailing Address - Country:US
Mailing Address - Phone:972-727-9995
Mailing Address - Fax:972-727-8350
Practice Address - Street 1:1125 RAINTREE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4900
Practice Address - Country:US
Practice Address - Phone:972-727-9995
Practice Address - Fax:972-727-8350
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9890207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202607201Medicaid
TXTXB117538OtherMEDICARE PART B - EFFECT. 02/01/2011
TX8CR165OtherBC/BS TX - EFFECT. 02/01/2011
TXP00913318OtherMEDICARE RAILROAD - EFFECT 02/01/2011
TX6484850004Medicare NSC
TX8L2946Medicare PIN
TX202607201Medicaid