Provider Demographics
NPI:1710931183
Name:BURRY, JULIET DANA (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:DANA
Last Name:BURRY
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:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-824-4990
Mailing Address - Fax:904-824-2226
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-671-5115
Practice Address - Fax:407-671-5116
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85974208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273128200Medicaid
FL273128200Medicaid
FLI35558Medicare UPIN