Provider Demographics
NPI:1679512321
Name:BURNSED, JOHN (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BURNSED
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 DR RUSSELL SMITH WAY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7402
Mailing Address - Country:US
Mailing Address - Phone:417-359-1849
Mailing Address - Fax:417-237-7259
Practice Address - Street 1:3125 DR RUSSELL SMITH WAY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7402
Practice Address - Country:US
Practice Address - Phone:417-359-1849
Practice Address - Fax:417-237-7259
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003001126207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200592160BMedicaid
OK200227870AMedicaid
AR175856003Medicaid
MO1679512321Medicaid
MOMA3446377Medicare PIN
MOH19767Medicare UPIN
AR175856003Medicaid