Provider Demographics
NPI:1831196559
Name:BURCH, CHARLES J (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:BURCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4458 MEDICAL DR
Mailing Address - Street 2:STE 505
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3748
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:210-957-6956
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:210-957-6956
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2018-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK2657174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010KHOtherBLUE CROSS
TX105831504Medicaid
TX8A7078OtherMEDICARE LEGACY NUMBER