Healthcare Provider Details

I. General information

NPI: 1073602439
Provider Name (Legal Business Name): MAIDA L BURROW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 BASELINE DR
GRAND JCT CO
81507-9583
US

IV. Provider business mailing address

2024 BASELINE DR
GRAND JCT CO
81507-9583
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-5785
  • Fax: 970-242-2559
Mailing address:
  • Phone: 970-243-5785
  • Fax: 970-242-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26621
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: