=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477568582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A. JAY BURNS, M.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9101 N CENTRAL EXPY SUITE 600
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-5927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-823-1978
-----------------------------------------------------
Fax | 214-818-4766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9101 N CENTRAL EXPY SUITE 600
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-5927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-823-1978
-----------------------------------------------------
Fax | 214-818-4766
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ALTON JAY BURNS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-823-1978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | F9258
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------