Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 44251 | CO |
NPI | 1003866484 |
---|---|
Provider Name | Dr. John Robert Burroughs |
First Address | Colorado Springs, CO 80907-4246 |
Second Address | Colorado Springs, CO 80907-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003866484 | NPI (01) | |
21637229 | (05) | CO |
DF0561 | RR MEDICARE (01) | |
I03917 | (02) |