Provider Demographics
NPI:1538277470
Name:BURDGE, SCOTT CAMERON (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CAMERON
Last Name:BURDGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21524 KINGSLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-829-9315
Mailing Address - Fax:281-829-1237
Practice Address - Street 1:21524 KINGSLAND BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6183
Practice Address - Country:US
Practice Address - Phone:281-829-9316
Practice Address - Fax:281-829-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1356213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084BTMedicare PIN