MEDICARE: DR. WAYNE RICHARD BURROWS MD

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	207V00000X	Obstetrics & Gynecology Physician	036.092595	IL

General Provider Information

NPI Number	:	1851910210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE RICHARD BURROWS MD

Provider Business Mailing Address
First Line	:	1412 S DIAMOND ST
Second Line	:
City	:	SOUTH JACKSONVILLE
State	:	IL
Zip	:	62650-3143
Country	:	US
Telephone Number	:	217-370-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 S DIAMOND ST
Second Line	:
City	:	SOUTH JACKSONVILLE
State	:	IL
Zip	:	62650-3143
Country	:	US
Telephone Number	:	217-370-0518
Fax Number	:

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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