Provider Demographics
NPI:1649295973
Name:BURRESS, JOHN DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:BURRESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1777
Mailing Address - Country:US
Mailing Address - Phone:352-259-7994
Mailing Address - Fax:352-259-7992
Practice Address - Street 1:607 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3792
Practice Address - Country:US
Practice Address - Phone:352-259-7994
Practice Address - Fax:352-259-7992
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080190404OtherRAILROAD MEDICARE
FL01116YOtherMEDICARE PTAN
FL01116OtherBCBS OF FLORIDA
FL01116ZOtherMEDICARE PTAN
FL01116ZOtherMEDICARE PTAN