Provider Demographics
NPI:1336201169
Name:BURROW, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BURROW
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 1:1204 SE 28TH STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3887
Mailing Address - Country:US
Mailing Address - Phone:479-268-3477
Mailing Address - Fax:479-268-3478
Practice Address - Street 1:1204 SE 28TH STREET
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3887
Practice Address - Country:US
Practice Address - Phone:479-268-3477
Practice Address - Fax:479-268-3478
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4964207Q00000X
ARE-4964207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16559901Medicaid
AR5N786Medicare UPIN