Provider Demographics
NPI:1386888428
Name:MAIDA L. BURROW M.D.
Entity type:Organization
Organization Name:MAIDA L. BURROW M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BURROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-242-0060
Mailing Address - Street 1:790 WELLINGTON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6127
Mailing Address - Country:US
Mailing Address - Phone:970-242-0060
Mailing Address - Fax:970-242-6604
Practice Address - Street 1:790 WELLINGTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6127
Practice Address - Country:US
Practice Address - Phone:970-242-0060
Practice Address - Fax:970-242-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26621207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29274OtherBCBS
CO26621Medicaid
C71841Medicare UPIN
COC14861Medicare PIN