1639411564 NPI number — DR. LLOYD SPENCER BURNS D.O.

Table of content: DR. LLOYD SPENCER BURNS D.O. (NPI 1639411564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639411564 NPI number — DR. LLOYD SPENCER BURNS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
LLOYD
Provider Middle Name:
SPENCER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
SPENCER
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639411564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 W OAKLEY DR S
Provider Second Line Business Mailing Address:
APT 201
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-6118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-225-0812
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 W OAKLEY DR S
Provider Second Line Business Practice Location Address:
APT 201
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-6118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-225-0812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  007234 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)