Healthcare Provider Details

I. General information

NPI: 1164414371
Provider Name (Legal Business Name): BRET DAVID BURTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3865
APO AE
09126
DE

IV. Provider business mailing address

UNIT 3865
APO AE
09126
DE

V. Phone/Fax

Practice location:
  • Phone: 01149656169
  • Fax: 3409
Mailing address:
  • Phone: 01149656169
  • Fax: 3409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ7315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: