Provider Demographics
NPI:1174677967
Name:BURNS, GERALD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ROBERT
Last Name:BURNS
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 1:111 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2080
Mailing Address - Country:US
Mailing Address - Phone:615-336-4506
Mailing Address - Fax:615-449-3625
Practice Address - Street 1:113 HIGHWAY 70 EAST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-446-5121
Practice Address - Fax:615-446-1357
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 5751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B03736Medicare UPIN
TN3381502Medicare ID - Type Unspecified
TNB03736Medicare UPIN
31769401Medicare PIN