Healthcare Provider Details

I. General information

NPI: 1235233818
Provider Name (Legal Business Name): A. KEITH BURNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E 12TH ST SUITE 100
THE DALLES OR
97058-3278
US

IV. Provider business mailing address

1615 E 12TH ST SUITE100
THE DALLES OR
97058-3278
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-1100
  • Fax: 541-236-0606
Mailing address:
  • Phone: 541-296-1100
  • Fax: 541-236-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD16765
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: