Provider Demographics
NPI:1003866484
Name:BURROUGHS, JOHN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 GARDEN OF THE GODS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-749-3606
Mailing Address - Fax:719-473-8581
Practice Address - Street 1:300 GARDEN OF THE GODS RD
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-473-8801
Practice Address - Fax:719-473-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO44251207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF0561OtherRR MEDICARE
1003866484OtherNPI
CO21637229Medicaid
1003866484OtherNPI
C804998Medicare PIN