Healthcare Provider Details

I. General information

NPI: 1033272810
Provider Name (Legal Business Name): BRUCE ELLIOTT BURNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/12/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDDAC-BAVARIA PSC 411 UNIT 28037
APO AE
09112-8037
US

IV. Provider business mailing address

PSC 411 BOX 6422
APO AE
09112-0065
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3524
  • Fax:
Mailing address:
  • Phone: 11-496-3719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA49064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: