Provider Demographics
NPI:1023177508
Name:BURY, RICHARD RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAYMOND
Last Name:BURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-778-5989
Mailing Address - Fax:303-778-8672
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-778-5989
Practice Address - Fax:303-778-8672
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01231752Medicaid
COD24230Medicare UPIN
COCN2208Medicare ID - Type UnspecifiedMEDICARE