Individual
DR. DEREGAL FAY BURBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
120 MEADOWCREST ST., SUITE 245, GRETNA, LA 70056
(504) 391-7690
(504) 391-7625
Mailing address
55 YELLOWSTONE DR, NEW ORLEANS, LA 70131
(225) 270-8370
(504) 392-0359
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
016402
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1324230
—
LA
Enumeration date
05/05/2008
Last updated
07/31/2009
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