MEDICARE: JULIET DANA BURRY 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	208VP0014X	Interventional Pain Medicine Physician	ME85974	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME85974	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710931183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIET DANA BURRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3123
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32085-3123
Country	:	US
Telephone Number	:	904-824-4990
Fax Number	:	904-824-2226

Provider Business Practice Location Address
First Line	:	499 E CENTRAL PKWY
Second Line	:	SUITE 115
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3402
Country	:	US
Telephone Number	:	407-671-5115
Fax Number	:	407-671-5116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/10/2013

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