Individual
FERNANDO BERNARD BURROUGHS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
1201 COLISEUM DRIVE, TUSCALOOSA, AL 35487-0001
(205) 348-3600
Mailing address
1201 COLISEUM DRIVE, TUSCALOOSA, AL 35487-0001
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
330
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
119702484
BOC
—
01
—
330
ALABAMA LICENSURE
AL
Enumeration date
11/03/2021
Last updated
11/03/2021
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