Healthcare Provider Details

I. General information

NPI: 1003866484
Provider Name (Legal Business Name): JOHN ROBERT BURROUGHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-473-8801
  • Fax: 719-473-8581
Mailing address:
  • Phone: 719-749-3606
  • Fax: 719-473-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44251
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number44251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: