Provider Demographics
NPI:1073793709
Name:BURR, SHANE J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:J
Last Name:BURR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HOWARD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3556
Mailing Address - Country:US
Mailing Address - Phone:308-398-8900
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE
Practice Address - Street 2:STE 105
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3556
Practice Address - Country:US
Practice Address - Phone:308-398-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25540208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation