Individual
LISA BOSARGE BURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 MEMORIAL HOSPITAL DR, SUITE 200, MOBILE, AL 36608-1786
(251) 414-5900
(251) 281-1265
Mailing address
101 MEMORIAL HOSPITAL DR, SUITE 200, MOBILE, AL 36608-1786
(251) 414-5900
(251) 281-1162
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00012790
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009994405
MEDICARE PTAN
AL
01
—
0401273
UNITED HEALTHCARE
AL
01
—
051527588
BCBS
AL
Enumeration date
07/13/2005
Last updated
05/18/2022
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