Provider Demographics
NPI:1801277637
Name:BURRIS, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BURRIS
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 1:24261 N US HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-9456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24261 N US HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:HOODSPORT
Practice Address - State:WA
Practice Address - Zip Code:98548-9456
Practice Address - Country:US
Practice Address - Phone:360-432-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60802385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine