Provider Demographics
NPI:1902863657
Name:BURG, TREY S (CRNA)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:S
Last Name:BURG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2018
Mailing Address - Country:US
Mailing Address - Phone:334-793-8087
Mailing Address - Fax:334-793-8191
Practice Address - Street 1:126 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2018
Practice Address - Country:US
Practice Address - Phone:334-793-8087
Practice Address - Fax:334-793-8191
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940555Medicaid
AL009940555Medicaid
AL051554328Medicare ID - Type Unspecified