1619977816 NPI number — DR. VALERIE BURTON MD

Table of content: DR. VALERIE BURTON MD (NPI 1619977816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619977816 NPI number — DR. VALERIE BURTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
VALERIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1619977816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 GEORGE BUSH HWY
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75082-3542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-343-6663
Provider Business Mailing Address Fax Number:
214-343-2814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12655 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-788-1858
Provider Business Practice Location Address Fax Number:
972-788-2798
Provider Enumeration Date:
07/29/2005

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: 2080P0006X , with the licence number:  M9183 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: M9183 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1113069 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M9183 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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