MEDICARE: CARLTON H. BURGE, P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0608P	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730327461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLTON H. BURGE, P.A

Provider Business Mailing Address
First Line	:	1 INNWOOD CIR
Second Line	:	STE 103
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-224-6888
Fax Number	:	501-224-6889

Provider Business Practice Location Address
First Line	:	1 INNWOOD CIR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2447
Country	:	US
Telephone Number	:	501-224-6888
Fax Number	:	501-224-6889

Authorized Official
Title or Position	:	OWNER
Name	:	CARLTON H BURGE
Credential	:
Telephone Number	:	501-224-6888

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	02/04/2009

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