Healthcare Provider Details

I. General information

NPI: 1346421179
Provider Name (Legal Business Name): JOHN R. BURROUGHS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN OF THE GODS STE. 100
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

300 GARDEN OF THE GODS STE. 100
COLORADO SPRINGS CO
80907-6267
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-8801
  • Fax: 719-473-8581
Mailing address:
  • Phone: 719-473-8801
  • Fax: 719-473-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44251
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number44251
License Number StateCO

VIII. Authorized Official

Name: JOHN R BURROUGHS
Title or Position: OWNER
Credential: MD
Phone: 719-473-8801