Provider Demographics
NPI:1801908108
Name:BURNS, TERRY L (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:BURNS
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 1:195 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529
Mailing Address - Country:US
Mailing Address - Phone:870-257-6060
Mailing Address - Fax:870-257-7664
Practice Address - Street 1:195 HOSPITAL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529
Practice Address - Country:US
Practice Address - Phone:870-257-6060
Practice Address - Fax:870-257-7664
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101356001Medicaid
50779OtherBCBS
ARP00690776OtherRAILROAD MEDICARE
AR101356001Medicaid