Healthcare Provider Details

I. General information

NPI: 1881669679
Provider Name (Legal Business Name): Office Of Dr. Ronald S. Burns
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N. 19th Avenue suite 213 5060 n 19th Avenue suite 213
PHOENIX AZ
85015-2402
US

IV. Provider business mailing address

5060 N, 19th Avenue suite 213 5060 N 19th Avenue suite 213
PHOENIX AZ
85015-2402
US

V. Phone/Fax

Practice location:
  • Phone: 602-562-1143
  • Fax: 844-548-2810
Mailing address:
  • Phone: 602-562-1143
  • Fax: 844-548-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology
License Number16073
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine
License Number16073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: