Provider Demographics
NPI:1235233818
Name:BURNS, A. KEITH (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:KEITH
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 1:1615 E 12TH ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3278
Mailing Address - Country:US
Mailing Address - Phone:541-296-1100
Mailing Address - Fax:541-236-0606
Practice Address - Street 1:1615 E 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3278
Practice Address - Country:US
Practice Address - Phone:541-296-1100
Practice Address - Fax:541-236-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16765207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1058510Medicaid
OR010160Medicaid
OR0000BKBHLMedicare PIN
WA1058510Medicaid
OR050011563Medicare PIN