Healthcare Provider Details

I. General information

NPI: 1316903834
Provider Name (Legal Business Name): MATTHEW H BURSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 28 3/4 RD
GRAND JUNCTION CO
81501-5016
US

IV. Provider business mailing address

PO BOX 22040
GREEN BAY WI
54305-2040
US

V. Phone/Fax

Practice location:
  • Phone: 970-683-7222
  • Fax: 970-683-7276
Mailing address:
  • Phone: 920-445-7222
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301506031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: