Provider Demographics
NPI:1982602108
Name:BURR, WAYNE MAHN (MD, FACP)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:MAHN
Last Name:BURR
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HOVEY ROAD
Mailing Address - Street 2:NAVY MEDICINE OPERATIONAL TRAINING CENTER
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1047
Mailing Address - Country:US
Mailing Address - Phone:850-452-2458
Mailing Address - Fax:
Practice Address - Street 1:220 HOVEY ROAD
Practice Address - Street 2:NAVY MEDICINE OPERATIONAL TRAINING CENTER
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1047
Practice Address - Country:US
Practice Address - Phone:850-452-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00427Medicare UPIN