Provider Demographics
NPI:1982605523
Name:BURNS, CRAIG W (DO)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:W
Last Name:BURNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 ALT 19
Mailing Address - Street 2:SUITE. B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1440
Mailing Address - Country:US
Mailing Address - Phone:727-935-6477
Mailing Address - Fax:727-935-6478
Practice Address - Street 1:4705 ALT 19
Practice Address - Street 2:SUITE. B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1440
Practice Address - Country:US
Practice Address - Phone:727-935-6477
Practice Address - Fax:727-935-6478
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH54005Medicare UPIN
FL24428Medicare ID - Type UnspecifiedGROUP
FLE6758YMedicare ID - Type Unspecified