Provider Demographics
NPI:1568440147
Name:ORR, WILLIAM BURTON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BURTON
Last Name:ORR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1800
Mailing Address - Country:US
Mailing Address - Phone:651-528-8183
Mailing Address - Fax:651-528-8184
Practice Address - Street 1:720 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:MENDOTA HTS
Practice Address - State:MN
Practice Address - Zip Code:55118-1800
Practice Address - Country:US
Practice Address - Phone:651-528-8183
Practice Address - Fax:651-528-8184
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1552349OtherMEDICA
MN774491900Medicaid
MN371M80ROtherBCBS OF MN
MN1552349OtherMEDICA
MN371M80ROtherBCBS OF MN