Provider Demographics
NPI:1336300334
Name:BURES, PAUL RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:BURES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 E ROYALTON RD STE 2600
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3532
Mailing Address - Country:US
Mailing Address - Phone:216-524-8883
Mailing Address - Fax:216-524-2125
Practice Address - Street 1:5901 E ROYALTON RD STE 2600
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-3532
Practice Address - Country:US
Practice Address - Phone:216-524-8883
Practice Address - Fax:216-524-2125
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.010989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program