Provider Demographics
NPI:1548880842
Name:BURNHAM, NATHANIEL DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:DAVID
Last Name:BURNHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2908
Mailing Address - Country:US
Mailing Address - Phone:682-509-6200
Mailing Address - Fax:
Practice Address - Street 1:408 CLARK ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-1953
Practice Address - Country:US
Practice Address - Phone:256-739-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6529207Q00000X
390200000X
ALDO.3102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program