Individual
BRUCE MALLORY BURNS
Active
Individual
BRUCE MALLORY BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13947
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00259223C
MEDICAID
GA
01
—
300020824
RAIL ROAD MEDICARE
SC
01
—
57-0853635
CHAMPUS
SC
05
—
TL4055
—
SC
Enumeration date
01/12/2007
Last updated
10/09/2007
Update your record
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