MEDICARE: MAIDA L. BURROW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	26621	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29274	OTHER	CO	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386888428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAIDA L. BURROW M.D.

Provider Business Mailing Address
First Line	:	790 WELLINGTON AVE STE 103
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6127
Country	:	US
Telephone Number	:	970-242-0060
Fax Number	:	970-242-6604

Provider Business Practice Location Address
First Line	:	790 WELLINGTON AVE STE 103
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-6127
Country	:	US
Telephone Number	:	970-242-0060
Fax Number	:	970-242-6604

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAIDA LOUISE BURROW
Credential	:	M.D.
Telephone Number	:	970-242-0060

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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