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Individual

DR. MALCOLM ROGER BURDICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
8059 SCYENE CIR, DALLAS, TX 75227-5562
(800) 257-8715
Mailing address
661 BROOKSIDE DR, CEDAR HILL, TX 75104-4710
(972) 291-8368

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
22091
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
170349801
TX
05
170349802
TX
05
170349803
TX
01
86979A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/22/2006
Last updated
07/08/2007
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