Provider Demographics
NPI:1407831225
Name:BURRIS, HUGH B JR (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:B
Last Name:BURRIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 NASA PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3304
Mailing Address - Country:US
Mailing Address - Phone:281-335-0606
Mailing Address - Fax:281-335-0208
Practice Address - Street 1:1202 NASA PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3304
Practice Address - Country:US
Practice Address - Phone:281-335-0606
Practice Address - Fax:281-335-0208
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9376207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F9293OtherBCBSTX PROV NO
TX1407831225OtherBCBSTX
TX1407831225OtherTRICARE SOUTH
TX120504906Medicaid
TX120504905Medicaid
TX8816B8Medicare PIN
TX930116437Medicare PIN
TX930121340Medicare PIN
TX8507B0Medicare PIN
TX8F9293OtherBCBSTX PROV NO