Basic Information
| Provider Information | |||||||||
| NPI: | 1578519922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURRIS | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1205 S GRANGE AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053288188 | ||||||||
| FaxNumber: | 6053288101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4695 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42828 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 42828 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 4695 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RN0300X | 42828 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 4695 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 2084A2900X | 4695 | SD | Y |
No ID Information.