Provider Demographics
NPI:1447244389
Name:BURRUSS, RICHARD P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:BURRUSS
Suffix:JR
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 1:401 E 8TH ST # 214-1974
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7011
Mailing Address - Country:US
Mailing Address - Phone:760-525-8516
Mailing Address - Fax:
Practice Address - Street 1:401 E 8TH ST # 214-1974
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7011
Practice Address - Country:US
Practice Address - Phone:760-525-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11968208D00000X
CAG59370207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG59370AMedicare ID - Type Unspecified
CAA93534Medicare UPIN