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General NPI Number Information
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NPI Number | 1073602439
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Entity Type | Individual
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Provider Name | MAIDA L BURROW MD
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 2024 BASELINE DR
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City | GRAND JCT
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State | CO
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Zip | 81507-9583
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Country | US
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Telephone | 970-243-5785
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Fax | 970-242-2559
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Provider Business Mailing Address
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Address Line | 2024 BASELINE DR
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City | GRAND JCT
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State | CO
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Zip | 81507-9583
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Country | US
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Telephone | 970-243-5785
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Fax | 970-242-2559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26621
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License Number State | CO
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