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NPI Code Detail

MEDICARE: JORY M BURROUGHS M.D.

MEDICARE: JORY M BURROUGHS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician46947MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134169246
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORY M BURROUGHS M.D.
Provider Business Mailing Address
First Line : 11207 STONEMILL FARMS CURV
Second Line :
City : WOODBURY
State : MN
Zip : 55129-5202
Country : US
Telephone Number : 651-337-0402
Fax Number :
Provider Business Practice Location Address
First Line : 300 STATE AVE
Second Line :
City : FARIBAULT
State : MN
Zip : 55021-6319
Country : US
Telephone Number : 507-333-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 11/02/2020

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