MEDICARE: DR. JOHN A BURROUGHS 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	207Q00000X	Family Medicine Physician	2000162372	MO

General Provider Information

NPI Number	:	1871562488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A BURROUGHS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 381
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64069-0381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 W KANSAS ST
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-2281
Country	:	US
Telephone Number	:	816-781-7400
Fax Number	:	816-781-3315

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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