Provider Demographics
NPI:1306895677
Name:BURR, ROBERT B (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:BURR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6510 S WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-8488
Mailing Address - Country:US
Mailing Address - Phone:509-939-5541
Mailing Address - Fax:509-448-3970
Practice Address - Street 1:12615 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1047
Practice Address - Country:US
Practice Address - Phone:509-939-5541
Practice Address - Fax:509-448-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002458103G00000X
IDPSY301103G00000X
UT276031-2501103G00000X
WY436103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134638Medicaid
WY123950300Medicaid
WA7134638Medicaid
WAG8861428Medicare PIN
UT000059946Medicare PIN