Provider Demographics
NPI:1760657126
Name:MACGEORGE BURNS, BRENDA MAE (DOM)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MAE
Last Name:MACGEORGE BURNS
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 DESERT MTN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3615
Mailing Address - Country:US
Mailing Address - Phone:505-237-1723
Mailing Address - Fax:
Practice Address - Street 1:4550 EUBANK BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3479
Practice Address - Country:US
Practice Address - Phone:505-298-8745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM615RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist