Provider Demographics
NPI:1891956165
Name:BURNS, LAURA ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANDERSON
Last Name:BURNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1543
Mailing Address - Country:US
Mailing Address - Phone:205-788-3321
Mailing Address - Fax:205-241-5260
Practice Address - Street 1:1700 AVENUE E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1543
Practice Address - Country:US
Practice Address - Phone:205-788-3321
Practice Address - Fax:205-241-5260
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130078Medicaid
AL511-16511OtherBLUE CROSS BLUE SHIELD OF AL
AL511-16512OtherBLUE CROSS BLUE SHIELD OF AL
AL130074Medicaid
AL130071Medicaid
AL511-16513OtherBLUE CROSS BLUE SHIELD OF ALABAMA