Provider Demographics
NPI:1598751729
Name:BURRUP, BYRON L (DO)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:L
Last Name:BURRUP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7201 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6709
Mailing Address - Country:US
Mailing Address - Phone:509-735-2325
Mailing Address - Fax:509-735-3222
Practice Address - Street 1:7201 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6709
Practice Address - Country:US
Practice Address - Phone:509-735-2325
Practice Address - Fax:509-735-3222
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB36203Medicare ID - Type Unspecified
F43587Medicare UPIN