Provider Demographics
NPI:1891814208
Name:RICHARD R BURY M.D., P.C.
Entity Type:Organization
Organization Name:RICHARD R BURY M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-778-5989
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-778-5989
Mailing Address - Fax:303-778-8672
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-778-5989
Practice Address - Fax:303-778-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01231752Medicaid
COC800905Medicare ID - Type UnspecifiedMEDICARE
CO01231752Medicaid