Basic Information
| Provider Information | |||||||||
| NPI: | 1942216627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURR | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 289 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622630289 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 N WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PINCKNEYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622741034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183572187 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | IL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | 07315815 | 01 | IL | BLUE SHIELD | OTHER | 04100096 | 01 | IL | BLUE SHIELD | OTHER |