Individual
CHARLES J BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21 SPURS LN, SUITE 230B, SAN ANTONIO, TX 78240-1669
(210) 690-7400
(210) 957-6956
Mailing address
4458 MEDICAL DR, STE 505, SAN ANTONIO, TX 78229-3748
(210) 690-7400
(210) 957-6956
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
K2657
TX
207RP1001X
Pulmonary Disease Physician
Primary
K2657
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010KH
BLUE CROSS
TX
05
—
105831504
—
TX
01
—
8A7078
MEDICARE LEGACY NUMBER
TX
Enumeration date
07/07/2005
Last updated
10/31/2018
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