Healthcare Provider Details

I. General information

NPI: 1437349081
Provider Name (Legal Business Name): LORI PATRICE BURREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI PATRICE SMITH-BURREY M.D.

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 E BIDWELL ST STE 100
FOLSOM CA
95630-6466
US

IV. Provider business mailing address

2170 E BIDWELL ST STE 100
FOLSOM CA
95630-6466
US

V. Phone/Fax

Practice location:
  • Phone: 916-983-8696
  • Fax:
Mailing address:
  • Phone: 916-983-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM9894
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50613
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA105155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: