Provider Demographics
NPI:1922428077
Name:BURNS, SAMUEL TUCKER (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TUCKER
Last Name:BURNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CENTRACARE DR
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-2100
Mailing Address - Country:US
Mailing Address - Phone:320-732-2131
Mailing Address - Fax:320-732-6913
Practice Address - Street 1:50 CENTRACARE DR
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-2100
Practice Address - Country:US
Practice Address - Phone:320-732-2131
Practice Address - Fax:320-732-6913
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62705208D00000X, 207Q00000X
IAMD-44699208D00000X
ARE-11506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice