Provider Demographics
NPI:1962529602
Name:BUREAU, CYNTHIA L (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:BUREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1610 JAMES BOWIE DR STE B101
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3367
Mailing Address - Country:US
Mailing Address - Phone:281-427-0019
Mailing Address - Fax:281-427-0531
Practice Address - Street 1:1610 JAMES BOWIE DR STE B101
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3367
Practice Address - Country:US
Practice Address - Phone:281-427-0019
Practice Address - Fax:281-427-0531
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58404Medicare UPIN
80460GMedicare ID - Type Unspecified