Provider Demographics
NPI:1780755470
Name:BURDETTE, DAVID CHAMBERS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHAMBERS
Last Name:BURDETTE
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 1:1431 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6500
Mailing Address - Country:US
Mailing Address - Phone:352-401-1308
Mailing Address - Fax:866-335-3101
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:352-401-1308
Practice Address - Fax:866-335-3101
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26844207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38617100Medicaid
FL38617100Medicaid
FL78955WMedicare ID - Type Unspecified
FL78955WMedicare PIN