Provider Demographics
NPI:1033157979
Name:BURROWS, OLIVER M (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:M
Last Name:BURROWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1377 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5047
Mailing Address - Country:US
Mailing Address - Phone:626-483-3348
Mailing Address - Fax:626-914-5316
Practice Address - Street 1:1377 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5047
Practice Address - Country:US
Practice Address - Phone:626-483-3348
Practice Address - Fax:626-914-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0023980Medicaid
CAGR0023980Medicaid
CAE87676Medicare UPIN