Active NPI
Fredrick Anthony Burris, M.D.
- Surgery Physician
- Ukiah, CA
National Provider Identifier
1245214907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- C33796
- Practice address
- 246 Hospital Dr
Ukiah, CA 95482-4533 - Phone
- (707) 463-8000
- Fax
- (707) 462-1111
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | C33796 | CA | Primary |
Addresses
Primary practice location
246 Hospital Dr
Ukiah, CA 95482-4533
Mailing address
PO Box 2739
Ukiah, CA 95482-2739
Phone (707) 463-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C337960 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33796 | CA | MD | Dentist |
| C33796 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308009600000",
"number": "1245214907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2739",
"city": "UKIAH",
"state": "CA",
"postal_code": "954822739",
"telephone_number": "707-463-8000",
"fax_number": "707-462-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 HOSPITAL DR",
"city": "UKIAH",
"state": "CA",
"postal_code": "954824533",
"telephone_number": "707-463-8000",
"fax_number": "707-462-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURRIS",
"first_name": "FREDRICK",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2011-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "C33796",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C337960",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.