Healthcare Provider Details

I. General information

NPI: 1255320438
Provider Name (Legal Business Name): ALLISON BURTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BUHNE ST A
EUREKA CA
95501-3238
US

IV. Provider business mailing address

2350 BUHNE ST A
EUREKA CA
95501-3238
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax: 707-443-6447
Mailing address:
  • Phone: 707-443-4593
  • Fax: 707-443-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA839110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA839110
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: