Provider Demographics
NPI:1871096958
Name:BURNS, LARRY LEON JR (PA - C)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LEON
Last Name:BURNS
Suffix:JR
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1201 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4229
Mailing Address - Country:US
Mailing Address - Phone:580-326-6423
Mailing Address - Fax:580-317-9233
Practice Address - Street 1:1201 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-317-9233
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant