Organization
CROWN OB/GYN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORY M BURROUGHS M.D. (PRESIDENT / OWNER)
(651) 209-0084
Entity
Organization
Contact information
Practice address
2056 WOODLANE DR, SUITE 100, WOODBURY, MN 55125-2917
(651) 209-0084
(651) 209-0388
Mailing address
2056 WOODLANE DR, SUITE 100, WOODBURY, MN 55125-2917
(651) 209-0084
(651) 209-0388
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
1817
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316228489
—
MN
Enumeration date
09/02/2011
Last updated
09/18/2012
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