Provider Demographics
NPI:1700851557
Name:BURMAN, GARY ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROBERT
Last Name:BURMAN
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 1:15035 EAST FWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4135
Mailing Address - Country:US
Mailing Address - Phone:281-457-0477
Mailing Address - Fax:281-457-6238
Practice Address - Street 1:15035 EAST FWY
Practice Address - Street 2:SUITE D
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4135
Practice Address - Country:US
Practice Address - Phone:281-457-0477
Practice Address - Fax:281-457-6238
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033779201Medicaid
TX414780OtherWELLCARE IDENTIFICATION NUMBER
TX9033679OtherCIGNA
10038712OtherAMERIGROUP
TX110148312OtherRAILROAD MEDICARE
TX4458279OtherAETNA
TXB0081062OtherDPS
TX8X6990OtherBLUE CROSS BLUE SHIELD
TXJ1204OtherLICENSE
TXJ1204OtherLICENSE
10038712OtherAMERIGROUP
TXJ1204OtherLICENSE
TXOOH72XMedicare ID - Type Unspecified