Healthcare Provider Details

I. General information

NPI: 1376722538
Provider Name (Legal Business Name): RONALD C BURTON M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD SUITE 509
MESA AZ
85202-4768
US

IV. Provider business mailing address

1432 S DOBSON RD SUITE 509
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-5111
  • Fax:
Mailing address:
  • Phone: 480-834-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number9421
License Number StateAZ

VIII. Authorized Official

Name: MONICA S STANDAGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-834-5111