Provider Demographics
NPI:1700988813
Name:FRED J BURFORD, II DO, PA
Entity Type:Organization
Organization Name:FRED J BURFORD, II DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUMBESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-337-9422
Mailing Address - Street 1:P.O. BOX 07267
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0267
Mailing Address - Country:US
Mailing Address - Phone:239-337-9422
Mailing Address - Fax:239-337-9421
Practice Address - Street 1:6120 WINKER RD
Practice Address - Street 2:SUITE H
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-337-9422
Practice Address - Fax:239-337-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE70603Medicare UPIN
FLQ0560Medicare PIN