Provider Demographics
NPI:1699785600
Name:BURDS, COLIN T (PA-C)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:T
Last Name:BURDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLIN
Other - Middle Name:T
Other - Last Name:EPPENAUER-BURDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-8221
Mailing Address - Fax:515-241-4001
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-8221
Practice Address - Fax:515-241-4001
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1699785600Medicaid
IAIB2171003Medicare PIN