Crown OB/GYN PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

1817 Issued in MN

Legal business name

CROWN OB/GYN PA

Practice address

2056 Woodlane Dr
Suite 100
Woodbury, MN 55125-2917

Phone

(651) 209-0084

Fax

(651) 209-0388

NPI assigned

Sep 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jory M Burroughs, M.D.

Title

President / Owner

Phone

(651) 209-0084

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1316228489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2056 WOODLANE DR",
            "address_2": "SUITE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252917",
            "telephone_number": "651-209-0084",
            "fax_number": "651-209-0388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2056 WOODLANE DR",
            "address_2": "SUITE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252917",
            "telephone_number": "651-209-0084",
            "fax_number": "651-209-0388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN OB/GYN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-02",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "BURROUGHS",
        "authorized_official_first_name": "JORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT / OWNER",
        "authorized_official_telephone_number": "651-209-0084",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "1817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316228489",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Woodbury, MN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.