Provider Demographics
NPI:1396832069
Name:BURNS, PAMELA R (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2210
Mailing Address - Country:US
Mailing Address - Phone:904-737-8686
Mailing Address - Fax:904-448-5414
Practice Address - Street 1:5978 POWERS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2210
Practice Address - Country:US
Practice Address - Phone:904-737-8686
Practice Address - Fax:904-448-5414
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048961207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME48961OtherFLORIDA MEDICAL LICENSE
FL02923VMedicare PIN
D50679Medicare UPIN