Healthcare Provider Details

I. General information

NPI: 1033176375
Provider Name (Legal Business Name): ANTHONY R. BURTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRESTWOOD CIR SUITE L
MENA AR
71953-5511
US

IV. Provider business mailing address

400 CRESTWOOD CIR SUITE L
MENA AR
71953-5511
US

V. Phone/Fax

Practice location:
  • Phone: 479-243-2160
  • Fax: 479-243-2375
Mailing address:
  • Phone: 479-243-2103
  • Fax: 479-243-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC6245
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: