1639295520 NPI number — MR. JOHN C BURTON PSYD

Table of content: MR. JOHN C BURTON PSYD (NPI 1639295520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639295520 NPI number — MR. JOHN C BURTON PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1639295520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOD RIVER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97031-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-288-8096
Provider Business Mailing Address Fax Number:
415-500-8275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E MARINA WAY
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-288-8096
Provider Business Practice Location Address Fax Number:
415-500-8275
Provider Enumeration Date:
03/22/2007

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: 103T00000X , with the licence number:  2631 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9968 . This is a "SFGH INTERNAL USE ONLY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9968 . This is a "CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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