Healthcare Provider Details

I. General information

NPI: 1568440147
Provider Name (Legal Business Name): WILLIAM BURTON ORR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MAIN ST STE 204
MENDOTA HTS MN
55118-1800
US

IV. Provider business mailing address

720 MAIN ST STE 204
MENDOTA HTS MN
55118-1800
US

V. Phone/Fax

Practice location:
  • Phone: 651-528-8183
  • Fax: 651-528-8184
Mailing address:
  • Phone: 651-528-8183
  • Fax: 651-528-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37479
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: