Individual
ROBERT WAYNE BURRIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8055 N 65TH ST, BROWN DEER, WI 53223-3408
(414) 881-1858
Mailing address
8055 N 65TH ST, BROWN DEER, WI 53223-3408
(414) 881-1858
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B620-7797-3121-06
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100008887
—
WI
Enumeration date
10/01/2021
Last updated
10/01/2021
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