Healthcare Provider Details

I. General information

NPI: 1831271022
Provider Name (Legal Business Name): BRUCE T BURTON, MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE SUITE 103
NEWPORT BEACH CA
92660-7702
US

IV. Provider business mailing address

450 NEWPORT CENTER DRIVE SUITE 650
NEWPORT BEACH CA
92660-7641
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-3600
  • Fax: 949-999-3648
Mailing address:
  • Phone: 949-999-3600
  • Fax: 949-999-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG42650
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE T BURTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243