Provider Demographics
NPI:1689692915
Name:BURCH, ANDREW D JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:BURCH
Suffix:JR
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:PO BOX 91436
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1436
Mailing Address - Country:US
Mailing Address - Phone:251-345-8878
Mailing Address - Fax:251-345-8095
Practice Address - Street 1:3715 DAUPHIN ST STE 6D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1774
Practice Address - Country:US
Practice Address - Phone:251-345-8878
Practice Address - Fax:251-345-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL18434208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520480Medicaid
F90677Medicare UPIN
AL051520480Medicaid