Healthcare Provider Details

I. General information

NPI: 1023242898
Provider Name (Legal Business Name): GREGORY BURNS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SAN JOSE DR
DUNEDIN FL
34698-3711
US

IV. Provider business mailing address

410 SAN JOSE DR
DUNEDIN FL
34698-3711
US

V. Phone/Fax

Practice location:
  • Phone: 406-438-7770
  • Fax:
Mailing address:
  • Phone: 406-438-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number271
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number271
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number271
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY9803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: