Provider Demographics
NPI:1760411243
Name:BURGIN, WILLIAM WALTER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:BURGIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60107
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-0107
Mailing Address - Country:US
Mailing Address - Phone:361-884-8200
Mailing Address - Fax:361-882-6649
Practice Address - Street 1:1702 HORNE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1902
Practice Address - Country:US
Practice Address - Phone:361-884-8200
Practice Address - Fax:361-882-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE1998207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110031826OtherRAILROAD MEDICARE
TX131957604Medicaid
TXE1998OtherSTATE LICENSE
TX00P934OtherBCBS OF TEXAS
TX131957604Medicaid
TX00P934Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH ENTERP