Provider Demographics
NPI:1356377667
Name:BURRY, ROBERT PAUL JR (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:BURRY
Suffix:JR
Gender:M
Credentials:DPM
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Mailing Address - Street 1:166 W TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1466
Mailing Address - Country:US
Mailing Address - Phone:570-836-2751
Mailing Address - Fax:570-836-3290
Practice Address - Street 1:166 W TIOGA ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1466
Practice Address - Country:US
Practice Address - Phone:570-836-2751
Practice Address - Fax:570-836-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2017-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASC-005746213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU98898Medicare UPIN