Provider Demographics
NPI:1609833995
Name:LEARNED-BURTON, LORI JO (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JO
Last Name:LEARNED-BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3008
Mailing Address - Country:US
Mailing Address - Phone:979-732-5771
Mailing Address - Fax:979-732-6922
Practice Address - Street 1:100 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3008
Practice Address - Country:US
Practice Address - Phone:979-732-5771
Practice Address - Fax:979-732-6922
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6238207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158464101Medicaid
TX158464102Medicaid
TX8F4226Medicare PIN
8A6291Medicare PIN
TX158464101Medicaid