1710997093 NPI number — DAVID A BURNS MD

Table of content: DAVID A BURNS MD (NPI 1710997093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710997093 NPI number — DAVID A BURNS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710997093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14560 CAVALLI RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98359-7516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-280-4112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14560 CAVALLI RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98359-7516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-280-4112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

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: 207L00000X , with the licence number:  4640-320 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: MD60057947 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: MD428777 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , with the licence number: CDR.0004964 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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