Provider Demographics
NPI:1689060907
Name:BURROUGHS-RAY, DESIREE (MD)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:BURROUGHS-RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:BURROUGHS-HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4119 C ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4053
Mailing Address - Country:US
Mailing Address - Phone:501-247-2199
Mailing Address - Fax:
Practice Address - Street 1:REGIONAL ONE HEALTH
Practice Address - Street 2:877 JEFFERSON AVENUE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58993208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program