Healthcare Provider Details

I. General information

NPI: 1518946193
Provider Name (Legal Business Name): ROBERT J BURI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AIR FORCE BASE AZ
85309-1529
US

IV. Provider business mailing address

7219 N LITCHFIELD RD
LUKE AIR FORCE BASE AZ
85309-1529
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-7579
  • Fax:
Mailing address:
  • Phone: 623-856-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005206
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number375
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: