Provider Demographics
NPI:1245277243
Name:BURNS, TIMOTHY J (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
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 1:4045 E BELL RD STE 157
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2240
Mailing Address - Country:US
Mailing Address - Phone:602-346-0204
Mailing Address - Fax:877-637-6691
Practice Address - Street 1:4045 E BELL RD STE 157
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2240
Practice Address - Country:US
Practice Address - Phone:602-346-0204
Practice Address - Fax:877-637-6691
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ127832Medicaid
AZ267650Medicaid
AZZWCKJD11Medicare PIN
AZZ11WCFGW01Medicare PIN
AZZ165484Medicare PIN
AZ267650Medicaid
AZ110034289Medicare PIN