Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R9429 | MO |
N | 111NI0900X | Internist | R9429 | MO |
Y | 207RH0002X | Hospice and Palliative Medicine | MOR9429 | MO |
NPI | 1174523047 |
---|---|
Provider Name | Dr. Edward Lee Burns JR. |
First Address | Saint Louis, MO 63128-2106 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 20/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201161635 | (05) | MO |
A13932 | (02) | MO |