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NPI Code Detail

MEDICARE: DR. JACK CHARLES BURNS II M.D.

MEDICARE: DR. JACK CHARLES BURNS II 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
12086S0122XPlastic and Reconstructive Surgery PhysicianR3446KY
22086S0122XPlastic and Reconstructive Surgery Physician29742WV

General Provider Information

NPI Number : 1922413889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK CHARLES BURNS II M.D.
Provider Business Mailing Address
First Line : 210 BROOKS ST STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-1848
Country : US
Telephone Number : 304-388-1930
Fax Number : 304-388-1929
Provider Business Practice Location Address
First Line : 210 BROOKS ST STE 200
Second Line :
City : CHARLESTON
State : WV
Zip : 25301-1848
Country : US
Telephone Number : 304-388-1930
Fax Number : 304-388-1929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 12/13/2023

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