Provider Demographics
NPI:1407058423
Name:BURNS, BRIAN JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFREY
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:PO BOX 650823
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0823
Mailing Address - Country:US
Mailing Address - Phone:720-264-5619
Mailing Address - Fax:
Practice Address - Street 1:6256 OXFORD PEAK CT
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-9467
Practice Address - Country:US
Practice Address - Phone:720-923-2344
Practice Address - Fax:720-367-0283
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0058074207R00000X
AZ40565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149634Medicaid
AZ345770Medicaid