Healthcare Provider Details

I. General information

NPI: 1982605523
Provider Name (Legal Business Name): CRAIG W BURNS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 ALT 19 SUITE. B
PALM HARBOR FL
34683-1440
US

IV. Provider business mailing address

4705 ALT 19 SUITE. B
PALM HARBOR FL
34683-1440
US

V. Phone/Fax

Practice location:
  • Phone: 727-935-6477
  • Fax: 727-935-6478
Mailing address:
  • Phone: 727-935-6477
  • Fax: 727-935-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: