Basic Information
| Provider Information | |||||||||
| NPI: | 1447688825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK BURNS, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11124 W CALIFORNIA AVE STE G | ||||||||
| Address2: | |||||||||
| City: | YOUNGTOWN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853631246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235832073 | ||||||||
| FaxNumber: | 6235831099 | ||||||||
| Practice Location | |||||||||
| Address1: | 11124 W CALIFORNIA AVE STE G | ||||||||
| Address2: | |||||||||
| City: | YOUNGTOWN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853631246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235832073 | ||||||||
| FaxNumber: | 6235831099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6235832073 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 29591 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 621674 | 05 | AZ | MEDICAID |