Provider Demographics
NPI:1467637694
Name:BURROUGHS, TONI MARIIA
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:MARIIA
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3140
Mailing Address - Country:US
Mailing Address - Phone:512-733-3869
Mailing Address - Fax:512-916-1601
Practice Address - Street 1:5405 HARVEST LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3140
Practice Address - Country:US
Practice Address - Phone:512-733-3869
Practice Address - Fax:512-916-1601
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization