Provider Demographics
NPI:1790861284
Name:BUROW, DAN P (PHD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:P
Last Name:BUROW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-3472
Mailing Address - Fax:210-615-2279
Practice Address - Street 1:2601 S MINNESOTA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4742
Practice Address - Country:US
Practice Address - Phone:605-335-3421
Practice Address - Fax:210-615-2279
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6551672Medicaid
SD6551672Medicaid