Provider Demographics
NPI:1245277417
Name:BURNS, JOHN M (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:BURNS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 OLD MOULTRIE RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5164
Mailing Address - Country:US
Mailing Address - Phone:904-825-0046
Mailing Address - Fax:904-826-1586
Practice Address - Street 1:1975 OLD MOULTRIE RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5164
Practice Address - Country:US
Practice Address - Phone:904-825-0046
Practice Address - Fax:904-826-1586
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3029213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65781VOtherMEDICARE ID
FL340503600Medicaid
FL65781VOtherMEDICARE ID