Provider Demographics
NPI:1851331474
Name:BURNS, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:BURNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:914B MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6706
Practice Address - Country:US
Practice Address - Phone:850-226-6572
Practice Address - Fax:850-862-8564
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9309208800000X
FLME112897208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01255861OtherRAILROAD MCR
FL0858508OtherCIGNA
FL14SM4OtherBCBS OF FL
FL1192950OtherWELLCARE
FL4736816OtherAETNA
AL592-22320OtherBCBS AL
AL000005985OtherBLUE CROSS
AL408113124OtherRAILROAD MEDICARE
AL000005985Medicaid
ALC76422OtherVIVA
MS05620202OtherMISSISSIPPI MEDICAID
FLP01255861OtherRAILROAD MCR
FLHP940ZMedicare PIN