Provider Demographics
NPI:1619094893
Name:VONMAUR, BURR (MD)
Entity Type:Individual
Prefix:DR
First Name:BURR
Middle Name:
Last Name:VONMAUR
Suffix:
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 1:1101 BAYSIDE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625
Mailing Address - Country:US
Mailing Address - Phone:949-718-6900
Mailing Address - Fax:949-718-9367
Practice Address - Street 1:1101 BAYSIDE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:949-718-6900
Practice Address - Fax:949-718-9367
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC037704208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC37704AMedicare PIN