Provider Demographics
NPI:1184654287
Name:BURNS, JOSEPH T (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7016207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND141997OtherUCARE #
NDDA9011015640OtherPREFERRED ONE #
ND80D80BUOtherMNBS #
ND0105999OtherMEDICA #
ND0108130OtherMEDICA #
ND6D845BUOtherMNBS #
NDND200224OtherLHS #
ND12051OtherSIOUX VALLEY #
ND18193Medicaid
ND3901622OtherMEDICA #
ND02T32BUOtherMNBS #
ND21580OtherNDBS #
ND166217100Medicaid
ND14746OtherNDBS #
ND900338OtherAMERICA'S PPO/ARAZ #
NDHP19520OtherHEALTHPARTNERS #
ND166217100Medicaid
ND18193Medicaid
NDDA9011015640OtherPREFERRED ONE #
ND14746OtherNDBS #
ND13219Medicare ID - Type UnspecifiedNE MEDICARE #