Provider Demographics
NPI:1740298397
Name:BURBIDGE, CATHRYN (DO)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:BURBIDGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20308
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0308
Mailing Address - Country:US
Mailing Address - Phone:254-848-7474
Mailing Address - Fax:
Practice Address - Street 1:27487 W HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-3717
Practice Address - Country:US
Practice Address - Phone:254-848-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042306302Medicaid
TX8F5616OtherBLUE CROSS BLUE SHIELD
00N59XOtherBLUE CROSS BLUE SHIELD
TX8K4020OtherBLUE CROSS BLUE SHIELD
TX038623706Medicaid
TX038623705Medicaid
TXP00414078Medicare PIN
TXP00152122Medicare PIN
TX8K4020OtherBLUE CROSS BLUE SHIELD
TX8F5616OtherBLUE CROSS BLUE SHIELD
TX8B3501Medicare PIN
TX610399Medicare PIN