Provider Demographics
NPI:1932106937
Name:BURPEAU, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BURPEAU
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 1:1200 BINZ ST STE 1130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6926
Mailing Address - Country:US
Mailing Address - Phone:713-529-0543
Mailing Address - Fax:713-529-9346
Practice Address - Street 1:1200 BINZ ST STE 1130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6926
Practice Address - Country:US
Practice Address - Phone:713-529-0543
Practice Address - Fax:713-529-9346
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXI4014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096523801Medicaid
TX00331GMedicare PIN
TX096523801Medicaid