Provider Demographics
NPI:1790840262
Name:BURNS, RICHARD JOSHUA (CCP LP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSHUA
Last Name:BURNS
Suffix:
Gender:M
Credentials:CCP LP
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 1378
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065
Mailing Address - Country:US
Mailing Address - Phone:405-392-3628
Mailing Address - Fax:405-392-2137
Practice Address - Street 1:2210 S HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065
Practice Address - Country:US
Practice Address - Phone:405-392-3628
Practice Address - Fax:405-392-2137
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP5247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
5993501OtherAETNA
731213482003OtherBCBS