Provider Demographics
NPI:1407058423
Name:BURNS, BRIAN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFREY
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 1:400 W CAMINO CASA VERDE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3564
Mailing Address - Country:US
Mailing Address - Phone:520-625-1760
Mailing Address - Fax:520-648-1394
Practice Address - Street 1:400 W CAMINO CASA VERDE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3564
Practice Address - Country:US
Practice Address - Phone:520-625-1760
Practice Address - Fax:520-648-1394
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ345770Medicaid
AZ345770Medicaid