Provider Demographics
NPI:1770713836
Name:DONALD A BURRESS MD PC
Entity type:Organization
Organization Name:DONALD A BURRESS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-665-5158
Mailing Address - Street 1:510 NE ROBERTS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7404
Mailing Address - Country:US
Mailing Address - Phone:503-665-5158
Mailing Address - Fax:503-665-5159
Practice Address - Street 1:510 NE ROBERTS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7404
Practice Address - Country:US
Practice Address - Phone:503-665-5158
Practice Address - Fax:503-665-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07309261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC92329Medicare UPIN
OR0000BBMXNMedicare PIN