Healthcare Provider Details

I. General information

NPI: 1790973808
Provider Name (Legal Business Name): JON NEWTON BURTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 NIKKI VIEW DR
BRANDON FL
33511-4879
US

IV. Provider business mailing address

10002 PRINCESS PALM AVE STE 332
TAMPA FL
33619-8327
US

V. Phone/Fax

Practice location:
  • Phone: 813-879-8045
  • Fax: 813-685-2477
Mailing address:
  • Phone: 813-571-7184
  • Fax: 813-654-4695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME115979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: