| Stan W Burleson Md Pa | |
|
705 W 16th St De Witt AR 72042-3414 | |
| (870) 946-1326 | |
| (870) 946-4577 |
| Full Name | Stan W Burleson Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 705 W 16th St, De Witt, Arkansas |
| Authorized Official Name and Position | Stanley Wayne Burleson (OWNER) |
| Authorized Official Contact | 8709461326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stan W Burleson Md Pa Po Box 32 De Witt AR 72042-0032 Ph: (870) 233-2214 | Stan W Burleson Md Pa 705 W 16th St De Witt AR 72042-3414 Ph: (870) 946-1326 |
| NPI Number | 1063104164 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 06/29/2023 |
| Medicare PECOS PAC ID | 4385006196 |
|---|---|
| Medicare Enrollment ID | O20230810002634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063104164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stanley W Burleson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295839397 PECOS PAC ID: 4688766181 Enrollment ID: I20080623000594 |
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