1043298417 NPI number — DR. DENNIS M BURTON M.D.

Table of content: DR. DENNIS M BURTON M.D. (NPI 1043298417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043298417 NPI number — DR. DENNIS M BURTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
DENNIS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043298417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22100 BOTHELL EVERETT HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-8431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-416-2932
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5206 SW SAVAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34990-5277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-678-6225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35.080751 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: 13392 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: 35.080751 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25MA09633100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MTL-2020-012 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0101239114 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD423152 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: M-2250 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME106918 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001948269 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0117468000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7615108 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00358707 . This is a "RAILROAD MC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0675774 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00152305 . This is a "RAILROAD MC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 113393100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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