Healthcare Provider Details

I. General information

NPI: 1861462335
Provider Name (Legal Business Name): BRUCE T BURTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE SUITE 103
NEWPORT BEACH CA
92660-7721
US

IV. Provider business mailing address

2415 CAMPUS DR SUITE 110
IRVINE CA
92612-1527
US

V. Phone/Fax

Practice location:
  • Phone: 949-718-3600
  • Fax:
Mailing address:
  • Phone: 949-999-3600
  • Fax: 949-999-3648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: