Individual
DR. BURCHAM COOPER FUQUA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3434 SARATOGA BLVD, CORPUS CHRISTI, TX 78415-5822
(361) 985-9355
(361) 992-3458
Mailing address
3434 SARATOGA BLVD, CORPUS CHRISTI, TX 78415-5822
(361) 985-9355
(361) 992-3458
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
F9456
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122175602
—
TX
05
—
122175606
—
TX
01
—
TXB149313
WELLMED PTAN
TX
Enumeration date
11/16/2005
Last updated
07/14/2016
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