Provider Demographics
NPI:1902889843
Name:BURSON, DAVID G (PA C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:BURSON
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 N DAVIS HWY
Mailing Address - Street 2:MEDICAL CENTER CLINIC URGENT CARE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8572
Mailing Address - Fax:850-474-8016
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8572
Practice Address - Fax:850-474-8016
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62277Medicare UPIN